Susan London

VANCOUVER, B.C. — When it comes to improving performance in young athletes, the tried and true approaches—such as a balanced diet and adequate training—trump the energy drinks, supplements, and drugs.

Although anabolic androgenic steroids increase muscle strength, they have inconsistent effects on aerobic performance. These steroids are known to increase the risk of atherosclerosis, but new research has implicated them in the development of hypertrophic cardiomyopathy, Dr. Bernard A. Griesemer said at a meeting on pediatric and adolescent sports medicine sponsored by the American Academy of Pediatrics.

It is unknown whether young athletes who begin using steroids in seventh or eighth grade are at a higher risk for hypertrophic cardiomyopathy than are mature athletes using the same chemicals, said Dr. Griesemer.

Anabolic steroids also have prothrombotic effects, and “consequently, the risk for coronary thrombosis has been reported,” said Dr. Griesemer of Missouri State University, Springfield.

The use of anabolic steroids for purely aesthetic and cosmetic purposes is on the rise, according to Dr. Griesemer. Several years ago, roughly 50% of users were noncompetitive body builders, but that value is now 78% (Med. Sci. Sports Exer. 2006;38:644–51). This means that increasing numbers of nonathlete middle school, high school, and college-age students are using these chemicals just to look good, he said, adding that “it's no longer just a sports medicine issue.”

Drugs such as androstene and androstenediol, which were previously available as supplements under the Dietary and Supplement Health and Education Act of 1994, have since been reclassified as controlled substances, whereas others with similar physiological effects, such as dehydroepiandrosterone (DHEA), have not. “The classification of these chemicals as a dietary supplement—you can get them at your local nutrition store—versus a class III controlled substance has probably more to do with politics and money than it has to do with biochemistry,” he said.

Stimulants have many positive ergogenic effects, but they also adversely affect athletic performance, mainly by causing diuresis, which puts athletes at increased risk for dehydration. In addition, stimulants can impair thermoregulatory mechanisms, and that may lead to heat stroke, he said.

Two potent stimulants—taurine and glucuronolactone—are found in energy drinks such as Red Bull, Vault, and Monster, which are available in the United States but have been withdrawn from the European Union market because of the risk of sudden death in young athletes, according to Dr. Griesemer. The risk may be especially high for children taking medications for attention-deficit/hyperactivity disorder, he said.

The ergogenic effects of creatine vary among individuals, according to Dr. Griesemer. It enhances performance in about a third of athletes, mainly those who play sports that require brief bursts of power, but even so, the gain is only 5%–7% at best. In another third of athletes, primarily those who play endurance sports, it negatively affects performance.

A related, newer phenomenon that physicians may encounter is “crystal vases,” the term given to highly muscled young athletes who consume energy drinks and protein or creatine supplements, engage in intense activity on hot days, and become dehydrated, leading to rhabdomyolysis.

“[These kids] look gorgeous, but those muscles don't sprain or strain; they tend to shatter,” Dr. Griesemer explained, noting that some affected young football players have creatine phosphokinase levels of 23,000 U/L or higher. Athletes taking selective serotonin reuptake inhibitors may be especially susceptible, said Dr. Griesemer, who reported that he had no disclosures in association with his presentation.

VANCOUVER, B.C. — When it comes to improving performance in young athletes, the tried and true approaches—such as a balanced diet and adequate training—trump the energy drinks, supplements, and drugs.

Although anabolic androgenic steroids increase muscle strength, they have inconsistent effects on aerobic performance. These steroids are known to increase the risk of atherosclerosis, but new research has implicated them in the development of hypertrophic cardiomyopathy, Dr. Bernard A. Griesemer said at a meeting on pediatric and adolescent sports medicine sponsored by the American Academy of Pediatrics.

It is unknown whether young athletes who begin using steroids in seventh or eighth grade are at a higher risk for hypertrophic cardiomyopathy than are mature athletes using the same chemicals, said Dr. Griesemer.

Anabolic steroids also have prothrombotic effects, and “consequently, the risk for coronary thrombosis has been reported,” said Dr. Griesemer of Missouri State University, Springfield.

The use of anabolic steroids for purely aesthetic and cosmetic purposes is on the rise, according to Dr. Griesemer. Several years ago, roughly 50% of users were noncompetitive body builders, but that value is now 78% (Med. Sci. Sports Exer. 2006;38:644–51). This means that increasing numbers of nonathlete middle school, high school, and college-age students are using these chemicals just to look good, he said, adding that “it's no longer just a sports medicine issue.”

Drugs such as androstene and androstenediol, which were previously available as supplements under the Dietary and Supplement Health and Education Act of 1994, have since been reclassified as controlled substances, whereas others with similar physiological effects, such as dehydroepiandrosterone (DHEA), have not. “The classification of these chemicals as a dietary supplement—you can get them at your local nutrition store—versus a class III controlled substance has probably more to do with politics and money than it has to do with biochemistry,” he said.

Stimulants have many positive ergogenic effects, but they also adversely affect athletic performance, mainly by causing diuresis, which puts athletes at increased risk for dehydration. In addition, stimulants can impair thermoregulatory mechanisms, and that may lead to heat stroke, he said.

Two potent stimulants—taurine and glucuronolactone—are found in energy drinks such as Red Bull, Vault, and Monster, which are available in the United States but have been withdrawn from the European Union market because of the risk of sudden death in young athletes, according to Dr. Griesemer. The risk may be especially high for children taking medications for attention-deficit/hyperactivity disorder, he said.

The ergogenic effects of creatine vary among individuals, according to Dr. Griesemer. It enhances performance in about a third of athletes, mainly those who play sports that require brief bursts of power, but even so, the gain is only 5%–7% at best. In another third of athletes, primarily those who play endurance sports, it negatively affects performance.

A related, newer phenomenon that physicians may encounter is “crystal vases,” the term given to highly muscled young athletes who consume energy drinks and protein or creatine supplements, engage in intense activity on hot days, and become dehydrated, leading to rhabdomyolysis.

“[These kids] look gorgeous, but those muscles don't sprain or strain; they tend to shatter,” Dr. Griesemer explained, noting that some affected young football players have creatine phosphokinase levels of 23,000 U/L or higher. Athletes taking selective serotonin reuptake inhibitors may be especially susceptible, said Dr. Griesemer, who reported that he had no disclosures in association with his presentation.

VANCOUVER, B.C. — When it comes to improving performance in young athletes, the tried and true approaches—such as a balanced diet and adequate training—trump the energy drinks, supplements, and drugs.

Although anabolic androgenic steroids increase muscle strength, they have inconsistent effects on aerobic performance. These steroids are known to increase the risk of atherosclerosis, but new research has implicated them in the development of hypertrophic cardiomyopathy, Dr. Bernard A. Griesemer said at a meeting on pediatric and adolescent sports medicine sponsored by the American Academy of Pediatrics.

It is unknown whether young athletes who begin using steroids in seventh or eighth grade are at a higher risk for hypertrophic cardiomyopathy than are mature athletes using the same chemicals, said Dr. Griesemer.

Anabolic steroids also have prothrombotic effects, and “consequently, the risk for coronary thrombosis has been reported,” said Dr. Griesemer of Missouri State University, Springfield.

The use of anabolic steroids for purely aesthetic and cosmetic purposes is on the rise, according to Dr. Griesemer. Several years ago, roughly 50% of users were noncompetitive body builders, but that value is now 78% (Med. Sci. Sports Exer. 2006;38:644–51). This means that increasing numbers of nonathlete middle school, high school, and college-age students are using these chemicals just to look good, he said, adding that “it's no longer just a sports medicine issue.”

Drugs such as androstene and androstenediol, which were previously available as supplements under the Dietary and Supplement Health and Education Act of 1994, have since been reclassified as controlled substances, whereas others with similar physiological effects, such as dehydroepiandrosterone (DHEA), have not. “The classification of these chemicals as a dietary supplement—you can get them at your local nutrition store—versus a class III controlled substance has probably more to do with politics and money than it has to do with biochemistry,” he said.

Stimulants have many positive ergogenic effects, but they also adversely affect athletic performance, mainly by causing diuresis, which puts athletes at increased risk for dehydration. In addition, stimulants can impair thermoregulatory mechanisms, and that may lead to heat stroke, he said.

Two potent stimulants—taurine and glucuronolactone—are found in energy drinks such as Red Bull, Vault, and Monster, which are available in the United States but have been withdrawn from the European Union market because of the risk of sudden death in young athletes, according to Dr. Griesemer. The risk may be especially high for children taking medications for attention-deficit/hyperactivity disorder, he said.

The ergogenic effects of creatine vary among individuals, according to Dr. Griesemer. It enhances performance in about a third of athletes, mainly those who play sports that require brief bursts of power, but even so, the gain is only 5%–7% at best. In another third of athletes, primarily those who play endurance sports, it negatively affects performance.

A related, newer phenomenon that physicians may encounter is “crystal vases,” the term given to highly muscled young athletes who consume energy drinks and protein or creatine supplements, engage in intense activity on hot days, and become dehydrated, leading to rhabdomyolysis.

“[These kids] look gorgeous, but those muscles don't sprain or strain; they tend to shatter,” Dr. Griesemer explained, noting that some affected young football players have creatine phosphokinase levels of 23,000 U/L or higher. Athletes taking selective serotonin reuptake inhibitors may be especially susceptible, said Dr. Griesemer, who reported that he had no disclosures in association with his presentation.

SEATTLE — Education and the collaborative efforts of a team of professionals are important for preventing the female athlete triad, according to Sharon H. Thompson, Ed.D.

The definition of the female athlete triad has been expanded recently, said Dr. Thompson, professor of health promotion at the Coastal Carolina University in Conway, S.C. Previously, the triad was viewed as consisting of disordered eating, amenorrhea, and osteoporosis. Now, athletes are considered to be affected if they have low energy, menstrual disorders, and low bone mineral density.

“The extent of disordered eating in athletes is really unclear,” Dr. Thompson said at an international conference sponsored by the Academy for Eating Disorders. Studies suggest that perhaps two-thirds of female athletes are affected. Athletes who are not consuming enough calories often become deficient in nutrients as well, and some of these (calcium, vitamin D, vitamin K, phosphorus, magnesium, and fluoride) are critical for bone health, she noted.

Amenorrhea in female athletes is associated with a two- to fourfold increased risk of stress fractures, Dr. Thompson said at the conference, which was cosponsored by the University of New Mexico. But they may have other types of menstrual dysfunction, including oligomenorrhea, anovulation, and luteal phase deficiency, which also affects bones.

It would be rare to find a female athlete who has frank osteoporosis, Dr. Thompson noted. However, “we know that athletes who have amenorrhea have 10%–25% lower bone mineral density at their lumbar spine, compared to control athletes. Bone loss may be accelerated in this population by estrogen deficiency, low energy availability, and a decreased rate of new bone formation.

“Bottom line, female athletes should have higher bone mineral density than nonfemale athletes,” she asserted. “Any female athlete who has lower bone mineral density is going to be more at risk for stress fractures and, it is also suggested, possibly more at risk for osteoporosis later on down the line.”

Of note, Dr. Thompson said, the female athlete triad's low energy availability leads to the other two components (menstrual disorders and low bone mineral density), and this has implications for prevention. “It's important that people who work with female athletes not necessarily look for all three of these together,” she stressed. “The low energy intake itself can lead to other problems.” And because the components can occur independently of each other, “prevention efforts are definitely needed for any of these problems.”

A survey that Dr. Thompson conducted among 300 female collegiate cross-country runners found that 83% had body mass indexes within the average category (J. Coll. Health. 2007;56:129–36). Some (19%) had previous or current eating disorders, but only a quarter of this group had ever been treated. In all, 23% had irregular menstrual cycles, and 29% had inadequate calcium intake, raising concerns about bone health. “The conclusion from this study is the importance of nutrition education for athletes, especially in the area of calcium-rich foods that might be added to their diet,” she said.

Educational efforts aimed at preventing the female athlete triad are lacking, according to Dr. Thompson. For example, fewer than 41% of Division I athletic teams and fewer than 33% of high schools have programs for their students that address eating disorders. Moreover, of high schools with such programs, 9% require athletes to attend, and 15% mandate the related education of coaches.

“It's important to realize, when [you screen] for the female athlete triad, that the main priority really should be looking for low energy intake,” Dr. Thompson said. She recommended that screening questions be part of the routine medical history to avoid calling undue attention to them. And athletes suspected of having disordered eating should be interviewed in person and given surveys that have been validated in this population (J. Athl. Train. 2008;43:80–108).

When drafting educational programs for athletes, institutions can refer to guidelines from the National Collegiate Athletic Association and the American College of Sports Medicine, Dr. Thompson said. Such programs should present factual information and resources on eating disorders, nutrition, weight, and menstrual health to avoid any stigmatization, she advised.

In addition, athletes should be made aware that treatment is not only available, but also effective. “I think that when they realize [treatment] can be helpful, and their performance can increase and they can feel better, then that's hopefully very attractive,” she said.

Noting that many coaches lack formal education on the female athlete triad, Dr. Thompson recommended mandatory, comprehensive training for this group at least annually so they are better prepared to prevent, recognize, and deal with the condition.

Certified athletic trainers can look to educational competencies for working with athletes outlined by the National Athletic Trainers' Association, according to Dr. Thompson. She noted that female trainers report feeling more confident in identifying athletes with eating disorders, which may suggest a need to better educate male trainers. Finally, she pointed out that 25% of trainers work at colleges that lack protocols for managing athletes with eating disorders, and recommended that universities—and high schools as well—establish such protocols.

“Prevention efforts do work and should be implemented,” Dr. Thompson concluded. “It's important that a team of professionals be there to work with athletes.” Mental health, athletic-training, medicine, and nutrition professionals; coaches; and athletic administrators “can all work together to improve the health of the female athlete.”

Dr. Thompson reported that her survey was funded by a grant from the South Carolina Osteoporosis Coalition, and the South Carolina Department of Health and Environmental Control.

A survey of 300 female collegiate cross-country runners found that 23% had irregular menstrual cycles. ©Galina

SEATTLE — Education and the collaborative efforts of a team of professionals are important for preventing the female athlete triad, according to Sharon H. Thompson, Ed.D.

The definition of the female athlete triad has been expanded recently, said Dr. Thompson, professor of health promotion at the Coastal Carolina University in Conway, S.C. Previously, the triad was viewed as consisting of disordered eating, amenorrhea, and osteoporosis. Now, athletes are considered to be affected if they have low energy, menstrual disorders, and low bone mineral density.

“The extent of disordered eating in athletes is really unclear,” Dr. Thompson said at an international conference sponsored by the Academy for Eating Disorders. Studies suggest that perhaps two-thirds of female athletes are affected. Athletes who are not consuming enough calories often become deficient in nutrients as well, and some of these (calcium, vitamin D, vitamin K, phosphorus, magnesium, and fluoride) are critical for bone health, she noted.

Amenorrhea in female athletes is associated with a two- to fourfold increased risk of stress fractures, Dr. Thompson said at the conference, which was cosponsored by the University of New Mexico. But they may have other types of menstrual dysfunction, including oligomenorrhea, anovulation, and luteal phase deficiency, which also affects bones.

It would be rare to find a female athlete who has frank osteoporosis, Dr. Thompson noted. However, “we know that athletes who have amenorrhea have 10%–25% lower bone mineral density at their lumbar spine, compared to control athletes. Bone loss may be accelerated in this population by estrogen deficiency, low energy availability, and a decreased rate of new bone formation.

“Bottom line, female athletes should have higher bone mineral density than nonfemale athletes,” she asserted. “Any female athlete who has lower bone mineral density is going to be more at risk for stress fractures and, it is also suggested, possibly more at risk for osteoporosis later on down the line.”

Of note, Dr. Thompson said, the female athlete triad's low energy availability leads to the other two components (menstrual disorders and low bone mineral density), and this has implications for prevention. “It's important that people who work with female athletes not necessarily look for all three of these together,” she stressed. “The low energy intake itself can lead to other problems.” And because the components can occur independently of each other, “prevention efforts are definitely needed for any of these problems.”

A survey that Dr. Thompson conducted among 300 female collegiate cross-country runners found that 83% had body mass indexes within the average category (J. Coll. Health. 2007;56:129–36). Some (19%) had previous or current eating disorders, but only a quarter of this group had ever been treated. In all, 23% had irregular menstrual cycles, and 29% had inadequate calcium intake, raising concerns about bone health. “The conclusion from this study is the importance of nutrition education for athletes, especially in the area of calcium-rich foods that might be added to their diet,” she said.

Educational efforts aimed at preventing the female athlete triad are lacking, according to Dr. Thompson. For example, fewer than 41% of Division I athletic teams and fewer than 33% of high schools have programs for their students that address eating disorders. Moreover, of high schools with such programs, 9% require athletes to attend, and 15% mandate the related education of coaches.

“It's important to realize, when [you screen] for the female athlete triad, that the main priority really should be looking for low energy intake,” Dr. Thompson said. She recommended that screening questions be part of the routine medical history to avoid calling undue attention to them. And athletes suspected of having disordered eating should be interviewed in person and given surveys that have been validated in this population (J. Athl. Train. 2008;43:80–108).

When drafting educational programs for athletes, institutions can refer to guidelines from the National Collegiate Athletic Association and the American College of Sports Medicine, Dr. Thompson said. Such programs should present factual information and resources on eating disorders, nutrition, weight, and menstrual health to avoid any stigmatization, she advised.

In addition, athletes should be made aware that treatment is not only available, but also effective. “I think that when they realize [treatment] can be helpful, and their performance can increase and they can feel better, then that's hopefully very attractive,” she said.

Noting that many coaches lack formal education on the female athlete triad, Dr. Thompson recommended mandatory, comprehensive training for this group at least annually so they are better prepared to prevent, recognize, and deal with the condition.

Certified athletic trainers can look to educational competencies for working with athletes outlined by the National Athletic Trainers' Association, according to Dr. Thompson. She noted that female trainers report feeling more confident in identifying athletes with eating disorders, which may suggest a need to better educate male trainers. Finally, she pointed out that 25% of trainers work at colleges that lack protocols for managing athletes with eating disorders, and recommended that universities—and high schools as well—establish such protocols.

“Prevention efforts do work and should be implemented,” Dr. Thompson concluded. “It's important that a team of professionals be there to work with athletes.” Mental health, athletic-training, medicine, and nutrition professionals; coaches; and athletic administrators “can all work together to improve the health of the female athlete.”

Dr. Thompson reported that her survey was funded by a grant from the South Carolina Osteoporosis Coalition, and the South Carolina Department of Health and Environmental Control.

A survey of 300 female collegiate cross-country runners found that 23% had irregular menstrual cycles. ©Galina

SEATTLE — Education and the collaborative efforts of a team of professionals are important for preventing the female athlete triad, according to Sharon H. Thompson, Ed.D.

The definition of the female athlete triad has been expanded recently, said Dr. Thompson, professor of health promotion at the Coastal Carolina University in Conway, S.C. Previously, the triad was viewed as consisting of disordered eating, amenorrhea, and osteoporosis. Now, athletes are considered to be affected if they have low energy, menstrual disorders, and low bone mineral density.

“The extent of disordered eating in athletes is really unclear,” Dr. Thompson said at an international conference sponsored by the Academy for Eating Disorders. Studies suggest that perhaps two-thirds of female athletes are affected. Athletes who are not consuming enough calories often become deficient in nutrients as well, and some of these (calcium, vitamin D, vitamin K, phosphorus, magnesium, and fluoride) are critical for bone health, she noted.

Amenorrhea in female athletes is associated with a two- to fourfold increased risk of stress fractures, Dr. Thompson said at the conference, which was cosponsored by the University of New Mexico. But they may have other types of menstrual dysfunction, including oligomenorrhea, anovulation, and luteal phase deficiency, which also affects bones.

It would be rare to find a female athlete who has frank osteoporosis, Dr. Thompson noted. However, “we know that athletes who have amenorrhea have 10%–25% lower bone mineral density at their lumbar spine, compared to control athletes. Bone loss may be accelerated in this population by estrogen deficiency, low energy availability, and a decreased rate of new bone formation.

“Bottom line, female athletes should have higher bone mineral density than nonfemale athletes,” she asserted. “Any female athlete who has lower bone mineral density is going to be more at risk for stress fractures and, it is also suggested, possibly more at risk for osteoporosis later on down the line.”

Of note, Dr. Thompson said, the female athlete triad's low energy availability leads to the other two components (menstrual disorders and low bone mineral density), and this has implications for prevention. “It's important that people who work with female athletes not necessarily look for all three of these together,” she stressed. “The low energy intake itself can lead to other problems.” And because the components can occur independently of each other, “prevention efforts are definitely needed for any of these problems.”

A survey that Dr. Thompson conducted among 300 female collegiate cross-country runners found that 83% had body mass indexes within the average category (J. Coll. Health. 2007;56:129–36). Some (19%) had previous or current eating disorders, but only a quarter of this group had ever been treated. In all, 23% had irregular menstrual cycles, and 29% had inadequate calcium intake, raising concerns about bone health. “The conclusion from this study is the importance of nutrition education for athletes, especially in the area of calcium-rich foods that might be added to their diet,” she said.

Educational efforts aimed at preventing the female athlete triad are lacking, according to Dr. Thompson. For example, fewer than 41% of Division I athletic teams and fewer than 33% of high schools have programs for their students that address eating disorders. Moreover, of high schools with such programs, 9% require athletes to attend, and 15% mandate the related education of coaches.

“It's important to realize, when [you screen] for the female athlete triad, that the main priority really should be looking for low energy intake,” Dr. Thompson said. She recommended that screening questions be part of the routine medical history to avoid calling undue attention to them. And athletes suspected of having disordered eating should be interviewed in person and given surveys that have been validated in this population (J. Athl. Train. 2008;43:80–108).

When drafting educational programs for athletes, institutions can refer to guidelines from the National Collegiate Athletic Association and the American College of Sports Medicine, Dr. Thompson said. Such programs should present factual information and resources on eating disorders, nutrition, weight, and menstrual health to avoid any stigmatization, she advised.

In addition, athletes should be made aware that treatment is not only available, but also effective. “I think that when they realize [treatment] can be helpful, and their performance can increase and they can feel better, then that's hopefully very attractive,” she said.

Noting that many coaches lack formal education on the female athlete triad, Dr. Thompson recommended mandatory, comprehensive training for this group at least annually so they are better prepared to prevent, recognize, and deal with the condition.

Certified athletic trainers can look to educational competencies for working with athletes outlined by the National Athletic Trainers' Association, according to Dr. Thompson. She noted that female trainers report feeling more confident in identifying athletes with eating disorders, which may suggest a need to better educate male trainers. Finally, she pointed out that 25% of trainers work at colleges that lack protocols for managing athletes with eating disorders, and recommended that universities—and high schools as well—establish such protocols.

“Prevention efforts do work and should be implemented,” Dr. Thompson concluded. “It's important that a team of professionals be there to work with athletes.” Mental health, athletic-training, medicine, and nutrition professionals; coaches; and athletic administrators “can all work together to improve the health of the female athlete.”

Dr. Thompson reported that her survey was funded by a grant from the South Carolina Osteoporosis Coalition, and the South Carolina Department of Health and Environmental Control.

A survey of 300 female collegiate cross-country runners found that 23% had irregular menstrual cycles. ©Galina

SEATTLE — Sizable proportions of adolescents progress along a spectrum of eating-disordered behavior over time, highlighting the importance of early detection and intervention, Diann M. Ackard, Ph.D., said at an international conference sponsored by the Academy for Eating Disorders.

Dr. Ackard, a psychologist in private practice in Golden Valley, Minn., and her colleagues assessed the stability of eating disorder classifications among a population-based sample of adolescents in Project EAT (Eating Among Teens). In the project, the same adolescents completed surveys about eating behaviors and body image in 1999 and again in 2004, and the survey items were mapped onto DSM-IV criteria.

Analyses were based on 2,516 adolescents in middle school or high school at the first assessment, Dr. Ackard reported at the conference, which was cosponsored by the University of New Mexico. Those in middle school were a mean age of 12.8 years and those in high school were a mean age of 15.8 years in 1999. Fifty-five percent were female.

At the first assessment, 10% of the adolescents met full-threshold criteria for a clinical eating disorder (anorexia nervosa, bulimia nervosa, or binge eating disorder), 39% had some subthreshold symptoms (compensatory behaviors or body image disturbance), and 50% were asymptomatic.

Five years later, considerable flux in the eating disorder groups was evident, Dr. Ackard reported. Among female adolescents who were asymptomatic at the first assessment, 63% remained so at follow-up—but 36% had developed symptoms and 1% had developed full clinical disorders. About 61% of those who initially had some symptoms still had them; another 37% had improved, becoming asymptomatic, but 3% had worsened and developed clinical disorders.

Among male adolescents who were asymptomatic at the first assessment, 74.5% remained so at the second assessment, but 25% had developed some symptoms and 0.4% had developed clinical disorders. And 38.8% of those who initially had some symptoms still had them; an additional 59.9% no longer had any symptoms, but 1.4% had progressed to a clinical disorder. Finally, all of the male adolescents who initially had a clinical disorder had improved to the point of having only some symptoms.

The study's good news, Dr. Ackard said, is that after 5 years, most asymptomatic youth (68.9% overall) remained symptom free, most with subclinical symptoms (52.4%) did not worsen to full clinical eating disorders and in fact 45.2% became asymptomatic.

In addition, most with clinical eating disorders improved to having only some subclinical symptoms (74%) or no symptoms (18%), said Dr. Ackard, also of the University of Minnesota, Minneapolis, and a research scientist at the Eating Disorders Institute at Park Nicollet Methodist Hospital, St. Louis Park, Minn.

On the flip side, some asymptomatic adolescents worsened to the point of having subclinical symptoms (30%) or clinical disorders (1%), others with symptoms progress to clinical disorders (2%), and a considerable proportion with clinical disorders still had them 5 years later (9%).

She reported that she had no conflicts of interest in association with the study.

Among females who were asymptomatic at the first assessment, 36% had developed symptoms. DR. ACKARD

SEATTLE — Sizable proportions of adolescents progress along a spectrum of eating-disordered behavior over time, highlighting the importance of early detection and intervention, Diann M. Ackard, Ph.D., said at an international conference sponsored by the Academy for Eating Disorders.

Dr. Ackard, a psychologist in private practice in Golden Valley, Minn., and her colleagues assessed the stability of eating disorder classifications among a population-based sample of adolescents in Project EAT (Eating Among Teens). In the project, the same adolescents completed surveys about eating behaviors and body image in 1999 and again in 2004, and the survey items were mapped onto DSM-IV criteria.

Analyses were based on 2,516 adolescents in middle school or high school at the first assessment, Dr. Ackard reported at the conference, which was cosponsored by the University of New Mexico. Those in middle school were a mean age of 12.8 years and those in high school were a mean age of 15.8 years in 1999. Fifty-five percent were female.

At the first assessment, 10% of the adolescents met full-threshold criteria for a clinical eating disorder (anorexia nervosa, bulimia nervosa, or binge eating disorder), 39% had some subthreshold symptoms (compensatory behaviors or body image disturbance), and 50% were asymptomatic.

Five years later, considerable flux in the eating disorder groups was evident, Dr. Ackard reported. Among female adolescents who were asymptomatic at the first assessment, 63% remained so at follow-up—but 36% had developed symptoms and 1% had developed full clinical disorders. About 61% of those who initially had some symptoms still had them; another 37% had improved, becoming asymptomatic, but 3% had worsened and developed clinical disorders.

Among male adolescents who were asymptomatic at the first assessment, 74.5% remained so at the second assessment, but 25% had developed some symptoms and 0.4% had developed clinical disorders. And 38.8% of those who initially had some symptoms still had them; an additional 59.9% no longer had any symptoms, but 1.4% had progressed to a clinical disorder. Finally, all of the male adolescents who initially had a clinical disorder had improved to the point of having only some symptoms.

The study's good news, Dr. Ackard said, is that after 5 years, most asymptomatic youth (68.9% overall) remained symptom free, most with subclinical symptoms (52.4%) did not worsen to full clinical eating disorders and in fact 45.2% became asymptomatic.

In addition, most with clinical eating disorders improved to having only some subclinical symptoms (74%) or no symptoms (18%), said Dr. Ackard, also of the University of Minnesota, Minneapolis, and a research scientist at the Eating Disorders Institute at Park Nicollet Methodist Hospital, St. Louis Park, Minn.

On the flip side, some asymptomatic adolescents worsened to the point of having subclinical symptoms (30%) or clinical disorders (1%), others with symptoms progress to clinical disorders (2%), and a considerable proportion with clinical disorders still had them 5 years later (9%).

She reported that she had no conflicts of interest in association with the study.

Among females who were asymptomatic at the first assessment, 36% had developed symptoms. DR. ACKARD

SEATTLE — Sizable proportions of adolescents progress along a spectrum of eating-disordered behavior over time, highlighting the importance of early detection and intervention, Diann M. Ackard, Ph.D., said at an international conference sponsored by the Academy for Eating Disorders.

Dr. Ackard, a psychologist in private practice in Golden Valley, Minn., and her colleagues assessed the stability of eating disorder classifications among a population-based sample of adolescents in Project EAT (Eating Among Teens). In the project, the same adolescents completed surveys about eating behaviors and body image in 1999 and again in 2004, and the survey items were mapped onto DSM-IV criteria.

Analyses were based on 2,516 adolescents in middle school or high school at the first assessment, Dr. Ackard reported at the conference, which was cosponsored by the University of New Mexico. Those in middle school were a mean age of 12.8 years and those in high school were a mean age of 15.8 years in 1999. Fifty-five percent were female.

At the first assessment, 10% of the adolescents met full-threshold criteria for a clinical eating disorder (anorexia nervosa, bulimia nervosa, or binge eating disorder), 39% had some subthreshold symptoms (compensatory behaviors or body image disturbance), and 50% were asymptomatic.

Five years later, considerable flux in the eating disorder groups was evident, Dr. Ackard reported. Among female adolescents who were asymptomatic at the first assessment, 63% remained so at follow-up—but 36% had developed symptoms and 1% had developed full clinical disorders. About 61% of those who initially had some symptoms still had them; another 37% had improved, becoming asymptomatic, but 3% had worsened and developed clinical disorders.

Among male adolescents who were asymptomatic at the first assessment, 74.5% remained so at the second assessment, but 25% had developed some symptoms and 0.4% had developed clinical disorders. And 38.8% of those who initially had some symptoms still had them; an additional 59.9% no longer had any symptoms, but 1.4% had progressed to a clinical disorder. Finally, all of the male adolescents who initially had a clinical disorder had improved to the point of having only some symptoms.

The study's good news, Dr. Ackard said, is that after 5 years, most asymptomatic youth (68.9% overall) remained symptom free, most with subclinical symptoms (52.4%) did not worsen to full clinical eating disorders and in fact 45.2% became asymptomatic.

In addition, most with clinical eating disorders improved to having only some subclinical symptoms (74%) or no symptoms (18%), said Dr. Ackard, also of the University of Minnesota, Minneapolis, and a research scientist at the Eating Disorders Institute at Park Nicollet Methodist Hospital, St. Louis Park, Minn.

On the flip side, some asymptomatic adolescents worsened to the point of having subclinical symptoms (30%) or clinical disorders (1%), others with symptoms progress to clinical disorders (2%), and a considerable proportion with clinical disorders still had them 5 years later (9%).

She reported that she had no conflicts of interest in association with the study.

Among females who were asymptomatic at the first assessment, 36% had developed symptoms. DR. ACKARD

SEATTLE – Education and the collaborative efforts of a team of professionals are important for preventing the female athlete triad, according to Sharon H. Thompson, Ed.D.

The definition of the female athlete triad has been expanded recently, said Dr. Thompson, professor of health promotion at the Coastal Carolina University in Conway, S.C. Previously, the triad was viewed as consisting of disordered eating, amenorrhea, and osteoporosis. Now, athletes are considered to be affected if they have low energy availability, menstrual disorders, and low bone mineral density.

“The extent of disordered eating in athletes is really unclear,” Dr. Thompson said at an international conference sponsored by the Academy for Eating Disorders. Studies suggest that perhaps two-thirds of female athletes are affected. Athletes who are not consuming enough calories often become deficient in nutrients as well, and some of these (calcium, vitamin D, vitamin K, phosphorus, magnesium, and fluoride) are critical for bone health, she noted.

Amenorrhea in female athletes is associated with a two- to fourfold increased risk of stress fractures, Dr. Thompson said at the conference, which was cosponsored by the University of New Mexico. But they may have other types of menstrual dysfunction, including oligomenorrhea, anovulation, and luteal phase deficiency, which also affects their bones.

“Very often, it's thought that if a female athlete doesn't have a menstrual cycle, it may be a sign of enough training or hard training, or [may even be] looked upon as a luxury,” she said. “But this certainly is not the case, because any disturbance of the menstrual cycle can affect bone health.”

It would be rare to find a female athlete who has frank osteoporosis, Dr. Thompson noted. However, “we know that athletes who have amenorrhea have 10%-25% lower bone mineral density at their lumbar spine, compared to control athletes. Bone loss may be accelerated in this population by estrogen deficiency, low energy availability, and a decreased rate of new bone formation.

“Bottom line, female athletes should have higher bone mineral density than non-female athletes,” she asserted. “Any female athlete who has lower bone mineral density is going to be more at risk for stress fractures and, it is also suggested, possibly more at risk for osteoporosis later on down the line.”

A survey that Dr. Thompson conducted among 300 female collegiate cross-country runners found that 83% had body mass indexes within the average category (J. Coll. Health. 2007;56:129-36). Some (19%) had previous or current eating disorders, but only a quarter of this group had ever been treated. In all, 23% had irregular menstrual cycles, and 29% had inadequate calcium intake, raising concerns about bone health. “The conclusion from this study is the importance of nutrition education for athletes, especially in the area of calcium-rich foods that might be added to their diet,” she said.

Educational efforts aimed at preventing the female athlete triad are generally lacking, according to Dr. Thompson. For example, fewer than 41% of Division I athletic teams and fewer than 33% of high schools have programs for their students that address eating disorders.

“It's important to realize, when [you screen] for the female athlete triad, that the main priority really should be looking for low energy intake, which of course could be some type of disordered eating for these female athletes,” Dr. Thompson said. She recommended that screening questions be part of the routine medical history to avoid calling undue attention to them. And athletes suspected of having disordered eating should be interviewed in person and given surveys that have been validated in this population (J. Athl. Train. 2008;43:80-108).

When drafting educational programs for athletes, institutions can refer to guidelines from the National Collegiate Athletic Association and the American College of Sports Medicine, Dr. Thompson said. Such programs should present factual information and resources on eating disorders, nutrition, weight, and menstrual health to avoid any stigmatization, she advised.

Since many coaches lack formal education on the female athlete triad, Dr. Thompson recommended mandatory, comprehensive training for this group at least annually so they are better prepared to recognize and deal with the condition.

“The bottom line is researchers have found that coaches who have more education are more likely to emphasize healthy eating rather than weight standards for their athletes,” she said.

Certified athletic trainers can look to educational competencies for working with athletes outlined by the National Athletic Trainers' Association, according to Dr. Thompson. “Prevention efforts do work and should be implemented,” Dr. Thompson concluded. “It's important that a team of professionals be there to work with athletes.” Mental health, athletic-training, medicine, and nutrition professionals; coaches; and athletic administrators “can all work together to improve the health of the female athlete.”

Dr. Thompson reported that her survey was funded by a grant from the South Carolina Osteoporosis Coalition, and the South Carolina Department of Health and Environmental Control.

A survey of 300 female collegiate cross-country runners found that 23% had irregular menstrual cycles. ©Galina Barskaya/Fotolia.com

SEATTLE – Education and the collaborative efforts of a team of professionals are important for preventing the female athlete triad, according to Sharon H. Thompson, Ed.D.

The definition of the female athlete triad has been expanded recently, said Dr. Thompson, professor of health promotion at the Coastal Carolina University in Conway, S.C. Previously, the triad was viewed as consisting of disordered eating, amenorrhea, and osteoporosis. Now, athletes are considered to be affected if they have low energy availability, menstrual disorders, and low bone mineral density.

“The extent of disordered eating in athletes is really unclear,” Dr. Thompson said at an international conference sponsored by the Academy for Eating Disorders. Studies suggest that perhaps two-thirds of female athletes are affected. Athletes who are not consuming enough calories often become deficient in nutrients as well, and some of these (calcium, vitamin D, vitamin K, phosphorus, magnesium, and fluoride) are critical for bone health, she noted.

Amenorrhea in female athletes is associated with a two- to fourfold increased risk of stress fractures, Dr. Thompson said at the conference, which was cosponsored by the University of New Mexico. But they may have other types of menstrual dysfunction, including oligomenorrhea, anovulation, and luteal phase deficiency, which also affects their bones.

“Very often, it's thought that if a female athlete doesn't have a menstrual cycle, it may be a sign of enough training or hard training, or [may even be] looked upon as a luxury,” she said. “But this certainly is not the case, because any disturbance of the menstrual cycle can affect bone health.”

It would be rare to find a female athlete who has frank osteoporosis, Dr. Thompson noted. However, “we know that athletes who have amenorrhea have 10%-25% lower bone mineral density at their lumbar spine, compared to control athletes. Bone loss may be accelerated in this population by estrogen deficiency, low energy availability, and a decreased rate of new bone formation.

“Bottom line, female athletes should have higher bone mineral density than non-female athletes,” she asserted. “Any female athlete who has lower bone mineral density is going to be more at risk for stress fractures and, it is also suggested, possibly more at risk for osteoporosis later on down the line.”

A survey that Dr. Thompson conducted among 300 female collegiate cross-country runners found that 83% had body mass indexes within the average category (J. Coll. Health. 2007;56:129-36). Some (19%) had previous or current eating disorders, but only a quarter of this group had ever been treated. In all, 23% had irregular menstrual cycles, and 29% had inadequate calcium intake, raising concerns about bone health. “The conclusion from this study is the importance of nutrition education for athletes, especially in the area of calcium-rich foods that might be added to their diet,” she said.

Educational efforts aimed at preventing the female athlete triad are generally lacking, according to Dr. Thompson. For example, fewer than 41% of Division I athletic teams and fewer than 33% of high schools have programs for their students that address eating disorders.

“It's important to realize, when [you screen] for the female athlete triad, that the main priority really should be looking for low energy intake, which of course could be some type of disordered eating for these female athletes,” Dr. Thompson said. She recommended that screening questions be part of the routine medical history to avoid calling undue attention to them. And athletes suspected of having disordered eating should be interviewed in person and given surveys that have been validated in this population (J. Athl. Train. 2008;43:80-108).

When drafting educational programs for athletes, institutions can refer to guidelines from the National Collegiate Athletic Association and the American College of Sports Medicine, Dr. Thompson said. Such programs should present factual information and resources on eating disorders, nutrition, weight, and menstrual health to avoid any stigmatization, she advised.

Since many coaches lack formal education on the female athlete triad, Dr. Thompson recommended mandatory, comprehensive training for this group at least annually so they are better prepared to recognize and deal with the condition.

“The bottom line is researchers have found that coaches who have more education are more likely to emphasize healthy eating rather than weight standards for their athletes,” she said.

Certified athletic trainers can look to educational competencies for working with athletes outlined by the National Athletic Trainers' Association, according to Dr. Thompson. “Prevention efforts do work and should be implemented,” Dr. Thompson concluded. “It's important that a team of professionals be there to work with athletes.” Mental health, athletic-training, medicine, and nutrition professionals; coaches; and athletic administrators “can all work together to improve the health of the female athlete.”

Dr. Thompson reported that her survey was funded by a grant from the South Carolina Osteoporosis Coalition, and the South Carolina Department of Health and Environmental Control.

A survey of 300 female collegiate cross-country runners found that 23% had irregular menstrual cycles. ©Galina Barskaya/Fotolia.com

SEATTLE – Education and the collaborative efforts of a team of professionals are important for preventing the female athlete triad, according to Sharon H. Thompson, Ed.D.

The definition of the female athlete triad has been expanded recently, said Dr. Thompson, professor of health promotion at the Coastal Carolina University in Conway, S.C. Previously, the triad was viewed as consisting of disordered eating, amenorrhea, and osteoporosis. Now, athletes are considered to be affected if they have low energy availability, menstrual disorders, and low bone mineral density.

“The extent of disordered eating in athletes is really unclear,” Dr. Thompson said at an international conference sponsored by the Academy for Eating Disorders. Studies suggest that perhaps two-thirds of female athletes are affected. Athletes who are not consuming enough calories often become deficient in nutrients as well, and some of these (calcium, vitamin D, vitamin K, phosphorus, magnesium, and fluoride) are critical for bone health, she noted.

Amenorrhea in female athletes is associated with a two- to fourfold increased risk of stress fractures, Dr. Thompson said at the conference, which was cosponsored by the University of New Mexico. But they may have other types of menstrual dysfunction, including oligomenorrhea, anovulation, and luteal phase deficiency, which also affects their bones.

“Very often, it's thought that if a female athlete doesn't have a menstrual cycle, it may be a sign of enough training or hard training, or [may even be] looked upon as a luxury,” she said. “But this certainly is not the case, because any disturbance of the menstrual cycle can affect bone health.”

It would be rare to find a female athlete who has frank osteoporosis, Dr. Thompson noted. However, “we know that athletes who have amenorrhea have 10%-25% lower bone mineral density at their lumbar spine, compared to control athletes. Bone loss may be accelerated in this population by estrogen deficiency, low energy availability, and a decreased rate of new bone formation.

“Bottom line, female athletes should have higher bone mineral density than non-female athletes,” she asserted. “Any female athlete who has lower bone mineral density is going to be more at risk for stress fractures and, it is also suggested, possibly more at risk for osteoporosis later on down the line.”

A survey that Dr. Thompson conducted among 300 female collegiate cross-country runners found that 83% had body mass indexes within the average category (J. Coll. Health. 2007;56:129-36). Some (19%) had previous or current eating disorders, but only a quarter of this group had ever been treated. In all, 23% had irregular menstrual cycles, and 29% had inadequate calcium intake, raising concerns about bone health. “The conclusion from this study is the importance of nutrition education for athletes, especially in the area of calcium-rich foods that might be added to their diet,” she said.

Educational efforts aimed at preventing the female athlete triad are generally lacking, according to Dr. Thompson. For example, fewer than 41% of Division I athletic teams and fewer than 33% of high schools have programs for their students that address eating disorders.

“It's important to realize, when [you screen] for the female athlete triad, that the main priority really should be looking for low energy intake, which of course could be some type of disordered eating for these female athletes,” Dr. Thompson said. She recommended that screening questions be part of the routine medical history to avoid calling undue attention to them. And athletes suspected of having disordered eating should be interviewed in person and given surveys that have been validated in this population (J. Athl. Train. 2008;43:80-108).

When drafting educational programs for athletes, institutions can refer to guidelines from the National Collegiate Athletic Association and the American College of Sports Medicine, Dr. Thompson said. Such programs should present factual information and resources on eating disorders, nutrition, weight, and menstrual health to avoid any stigmatization, she advised.

Since many coaches lack formal education on the female athlete triad, Dr. Thompson recommended mandatory, comprehensive training for this group at least annually so they are better prepared to recognize and deal with the condition.

“The bottom line is researchers have found that coaches who have more education are more likely to emphasize healthy eating rather than weight standards for their athletes,” she said.

Certified athletic trainers can look to educational competencies for working with athletes outlined by the National Athletic Trainers' Association, according to Dr. Thompson. “Prevention efforts do work and should be implemented,” Dr. Thompson concluded. “It's important that a team of professionals be there to work with athletes.” Mental health, athletic-training, medicine, and nutrition professionals; coaches; and athletic administrators “can all work together to improve the health of the female athlete.”

Dr. Thompson reported that her survey was funded by a grant from the South Carolina Osteoporosis Coalition, and the South Carolina Department of Health and Environmental Control.

A survey of 300 female collegiate cross-country runners found that 23% had irregular menstrual cycles. ©Galina Barskaya/Fotolia.com

SEATTLE – Patients with eating disorders who receive emotion-focused therapy experience a decrease in psychological morbidity and possible reductions in bingeing and vomiting, preliminary results of the first evaluation of this therapy for eating disorders show.

“Affect has long been implicated in triggering eating disorder symptoms. Difficulties with affect regulation characterize the population,” Leslie Greenberg, Ph.D., told people attending an international conference sponsored by the Academy for Eating Disorders.

In an emotion-focused therapy (EFT) model, the activation of emotion schematic memories and the experience of overwhelming affect play key roles in the pathogenesis of these disorders. “A central function in our view of the eating disorder [is that it] can be understood as an attempt to control affect,” he said at the conference, which was cosponsored by the University of New Mexico.

EFT is an evidence-based treatment for depression, trauma, and couples distress, noted Dr. Greenberg, who is director of the psychotherapy research center at York University, Toronto.

“The hypothesized effect of EFT for eating disorders is that it will enhance people's sense of efficacy about dealing with the eating disorder, leading to change in dysfunctional behavior patterns,” he said. When patients are able to understand that the disorder is functioning to regulate their emotions, they are then able to handle their emotions in a new way, which gives rise to a sense of hope that they can also control the disorder, he said.

“Once the emotions have been dealt with, this will render the eating disorder unnecessary as a means of coping,” he said.

Dr. Greenberg and his colleagues enrolled 14 women with eating disorders in the study. The average age of the women was 33 years. Seven (50%) of them had bulimia nervosa, four (29%) had binge-eating disorder, and three (21%) had an eating disorder not otherwise specified. The mean duration of eating problems was nearly 20 years.

The women were equally divided into two groups and received group EFT consisting of 16 weekly sessions, each lasting 2 hours. In the first session, the therapist focused on psychoeducation about eating and emotions, according to Dr. Greenberg. In the remaining sessions, two or three women engaged in dialogue on self-critical issues, self-interruptive issues, and unfinished business.

On average, the women attended about 12 sessions and had five chair-work treatments. Therapists reported that the women in group 1 (a start-up group) had a comparatively higher prevalence of atypical eating disorder presentations and Axis II disorders, as well as poorer attendance. Those in group 2 had a higher prevalence of typical eating-disorder presentations and greater focus.

The results, which Dr. Greenberg stressed were preliminary, indicated that after therapy, the patients had significant improvements from baseline in scores on the Difficulties in Emotion Regulation Scale, the Beck Depression Inventory, and the Symptom Checklist-90. They also had nonsignificant improvements in scores on the Toronto Alexithymia Scale and the Rosenberg Self-Esteem Scale.

In the two groups combined, there were nonsignificant reductions in the number of bingeing episodes (from roughly 14 to 9 in a 2-week period) and the number of vomiting episodes (from roughly 4 to 2 in a 2-week period). However, when group 2 was analyzed alone, the reduction was significant.

Dr. Greenberg noted that two patients in group 1 actually began bingeing more during therapy. “Both worked on abuse or separation issues, and they got quite dysregulated within the group. But this is not necessarily bad,” he said “This is one of the cases of sometimes getting worse before you get better.”

Both patients entered individual EFT and one entered day treatment, and they eventually became asymptomatic. In group 2, all patients had a reduction in bingeing, and three no longer binged at all after therapy. There was also a comparable reduction in vomiting in this group. “So we see that this is possibly a mechanism, that people feel now more hope that they will be able to tackle the eating disorder because they have some understanding of their emotional process and its relationship to their eating disorder,” Dr. Greenberg said.

Finally, when patients rated the helpfulness of various aspects of EFT, they gave highest scores to learning what they needed in response to their emotions (mean score on a 0-6 scale, 5.82) and feeling understood by group leaders (5.82), he said.

Other aspects of EFT that they found helpful included doing self-critical chair work (5.73), understanding how their emotions and symptoms connected (5.72), gaining awareness of their emotions (5.64), and feeling understood by other members of their group (5.55).

Dr. Greenberg reported that he had no conflicts of interest in association with the study.

This treatment should 'enhance people's sense of efficacy about dealing with the eating disorder.' DR. GREENBERG

SEATTLE – Patients with eating disorders who receive emotion-focused therapy experience a decrease in psychological morbidity and possible reductions in bingeing and vomiting, preliminary results of the first evaluation of this therapy for eating disorders show.

“Affect has long been implicated in triggering eating disorder symptoms. Difficulties with affect regulation characterize the population,” Leslie Greenberg, Ph.D., told people attending an international conference sponsored by the Academy for Eating Disorders.

In an emotion-focused therapy (EFT) model, the activation of emotion schematic memories and the experience of overwhelming affect play key roles in the pathogenesis of these disorders. “A central function in our view of the eating disorder [is that it] can be understood as an attempt to control affect,” he said at the conference, which was cosponsored by the University of New Mexico.

EFT is an evidence-based treatment for depression, trauma, and couples distress, noted Dr. Greenberg, who is director of the psychotherapy research center at York University, Toronto.

“The hypothesized effect of EFT for eating disorders is that it will enhance people's sense of efficacy about dealing with the eating disorder, leading to change in dysfunctional behavior patterns,” he said. When patients are able to understand that the disorder is functioning to regulate their emotions, they are then able to handle their emotions in a new way, which gives rise to a sense of hope that they can also control the disorder, he said.

“Once the emotions have been dealt with, this will render the eating disorder unnecessary as a means of coping,” he said.

Dr. Greenberg and his colleagues enrolled 14 women with eating disorders in the study. The average age of the women was 33 years. Seven (50%) of them had bulimia nervosa, four (29%) had binge-eating disorder, and three (21%) had an eating disorder not otherwise specified. The mean duration of eating problems was nearly 20 years.

The women were equally divided into two groups and received group EFT consisting of 16 weekly sessions, each lasting 2 hours. In the first session, the therapist focused on psychoeducation about eating and emotions, according to Dr. Greenberg. In the remaining sessions, two or three women engaged in dialogue on self-critical issues, self-interruptive issues, and unfinished business.

On average, the women attended about 12 sessions and had five chair-work treatments. Therapists reported that the women in group 1 (a start-up group) had a comparatively higher prevalence of atypical eating disorder presentations and Axis II disorders, as well as poorer attendance. Those in group 2 had a higher prevalence of typical eating-disorder presentations and greater focus.

The results, which Dr. Greenberg stressed were preliminary, indicated that after therapy, the patients had significant improvements from baseline in scores on the Difficulties in Emotion Regulation Scale, the Beck Depression Inventory, and the Symptom Checklist-90. They also had nonsignificant improvements in scores on the Toronto Alexithymia Scale and the Rosenberg Self-Esteem Scale.

In the two groups combined, there were nonsignificant reductions in the number of bingeing episodes (from roughly 14 to 9 in a 2-week period) and the number of vomiting episodes (from roughly 4 to 2 in a 2-week period). However, when group 2 was analyzed alone, the reduction was significant.

Dr. Greenberg noted that two patients in group 1 actually began bingeing more during therapy. “Both worked on abuse or separation issues, and they got quite dysregulated within the group. But this is not necessarily bad,” he said “This is one of the cases of sometimes getting worse before you get better.”

Both patients entered individual EFT and one entered day treatment, and they eventually became asymptomatic. In group 2, all patients had a reduction in bingeing, and three no longer binged at all after therapy. There was also a comparable reduction in vomiting in this group. “So we see that this is possibly a mechanism, that people feel now more hope that they will be able to tackle the eating disorder because they have some understanding of their emotional process and its relationship to their eating disorder,” Dr. Greenberg said.

Finally, when patients rated the helpfulness of various aspects of EFT, they gave highest scores to learning what they needed in response to their emotions (mean score on a 0-6 scale, 5.82) and feeling understood by group leaders (5.82), he said.

Other aspects of EFT that they found helpful included doing self-critical chair work (5.73), understanding how their emotions and symptoms connected (5.72), gaining awareness of their emotions (5.64), and feeling understood by other members of their group (5.55).

Dr. Greenberg reported that he had no conflicts of interest in association with the study.

This treatment should 'enhance people's sense of efficacy about dealing with the eating disorder.' DR. GREENBERG

SEATTLE – Patients with eating disorders who receive emotion-focused therapy experience a decrease in psychological morbidity and possible reductions in bingeing and vomiting, preliminary results of the first evaluation of this therapy for eating disorders show.

“Affect has long been implicated in triggering eating disorder symptoms. Difficulties with affect regulation characterize the population,” Leslie Greenberg, Ph.D., told people attending an international conference sponsored by the Academy for Eating Disorders.

In an emotion-focused therapy (EFT) model, the activation of emotion schematic memories and the experience of overwhelming affect play key roles in the pathogenesis of these disorders. “A central function in our view of the eating disorder [is that it] can be understood as an attempt to control affect,” he said at the conference, which was cosponsored by the University of New Mexico.

EFT is an evidence-based treatment for depression, trauma, and couples distress, noted Dr. Greenberg, who is director of the psychotherapy research center at York University, Toronto.

“The hypothesized effect of EFT for eating disorders is that it will enhance people's sense of efficacy about dealing with the eating disorder, leading to change in dysfunctional behavior patterns,” he said. When patients are able to understand that the disorder is functioning to regulate their emotions, they are then able to handle their emotions in a new way, which gives rise to a sense of hope that they can also control the disorder, he said.

“Once the emotions have been dealt with, this will render the eating disorder unnecessary as a means of coping,” he said.

Dr. Greenberg and his colleagues enrolled 14 women with eating disorders in the study. The average age of the women was 33 years. Seven (50%) of them had bulimia nervosa, four (29%) had binge-eating disorder, and three (21%) had an eating disorder not otherwise specified. The mean duration of eating problems was nearly 20 years.

The women were equally divided into two groups and received group EFT consisting of 16 weekly sessions, each lasting 2 hours. In the first session, the therapist focused on psychoeducation about eating and emotions, according to Dr. Greenberg. In the remaining sessions, two or three women engaged in dialogue on self-critical issues, self-interruptive issues, and unfinished business.

On average, the women attended about 12 sessions and had five chair-work treatments. Therapists reported that the women in group 1 (a start-up group) had a comparatively higher prevalence of atypical eating disorder presentations and Axis II disorders, as well as poorer attendance. Those in group 2 had a higher prevalence of typical eating-disorder presentations and greater focus.

The results, which Dr. Greenberg stressed were preliminary, indicated that after therapy, the patients had significant improvements from baseline in scores on the Difficulties in Emotion Regulation Scale, the Beck Depression Inventory, and the Symptom Checklist-90. They also had nonsignificant improvements in scores on the Toronto Alexithymia Scale and the Rosenberg Self-Esteem Scale.

In the two groups combined, there were nonsignificant reductions in the number of bingeing episodes (from roughly 14 to 9 in a 2-week period) and the number of vomiting episodes (from roughly 4 to 2 in a 2-week period). However, when group 2 was analyzed alone, the reduction was significant.

Dr. Greenberg noted that two patients in group 1 actually began bingeing more during therapy. “Both worked on abuse or separation issues, and they got quite dysregulated within the group. But this is not necessarily bad,” he said “This is one of the cases of sometimes getting worse before you get better.”

Both patients entered individual EFT and one entered day treatment, and they eventually became asymptomatic. In group 2, all patients had a reduction in bingeing, and three no longer binged at all after therapy. There was also a comparable reduction in vomiting in this group. “So we see that this is possibly a mechanism, that people feel now more hope that they will be able to tackle the eating disorder because they have some understanding of their emotional process and its relationship to their eating disorder,” Dr. Greenberg said.

Finally, when patients rated the helpfulness of various aspects of EFT, they gave highest scores to learning what they needed in response to their emotions (mean score on a 0-6 scale, 5.82) and feeling understood by group leaders (5.82), he said.

Other aspects of EFT that they found helpful included doing self-critical chair work (5.73), understanding how their emotions and symptoms connected (5.72), gaining awareness of their emotions (5.64), and feeling understood by other members of their group (5.55).

Dr. Greenberg reported that he had no conflicts of interest in association with the study.

This treatment should 'enhance people's sense of efficacy about dealing with the eating disorder.' DR. GREENBERG

SEATTLE – Initial improvements in anorexia nervosa and bulimia nervosa achieved in an intensive residential treatment program are largely sustained 4-5 years later, Dr. Timothy D. Brewerton reported.

“Data on long-term follow-up of individuals with anorexia nervosa and bulimia nervosa following intensive inpatient or residential treatment are limited,” said Dr. Brewerton, a psychiatrist at the Medical University of South Carolina, Charleston, who also is in private practice in Mt. Pleasant, S.C. “Many studies are primarily on adolescents and/or outpatients, and others have included individuals who have not received any treatment.”

The investigators surveyed patients with eating disorders who had received at least 30 days of treatment in a residential program in Malibu, Calif. Outcomes on the Eating Disorder Inventory-2 (EDI-2), the Beck Depression Inventory (BDI), and a structured eating disorder assessment were evaluated at three time points: admission, discharge, and the most recent of 13 postgraduate follow-ups, which ranged from 1 to 10 years.

Analyses were based on 85 patients with anorexia and 71 patients with bulimia. The mean time between discharge and postgraduate follow-up was 4.5 and 4.1 years, respectively. On average, the patients in each group were about 30 years old (range, 17-57).

In the anorexia group, mean BMI scores (reported by a physician, therapist, or dietician) increased significantly between admission and discharge (from 16 to 18), Dr. Brewerton told those attending an international conference sponsored by the Academy for Eating Disorders. Moreover, a further significant increase was seen from discharge to postgraduate follow-up (from 18 to 19).

By discharge, the patients with anorexia had significant improvements in 9 of 11 subscales of the EDI-2. They had further significant improvements in five of the subscales–drive for thinness, body dissatisfaction, interoceptive awareness, maturity fears, and asceticism–between discharge and postgraduate follow-up.

The percentage of anorexia patients with a good outcome, defined as a return of body mass index (BMI) to at least 18 and normal menses, increased between discharge and postgraduate follow-up (from 19% to 41%). At the same time, there was a decrease in the percentages with an intermediate outcome, defined as restoration of BMI or normal menses (from 48% to 46%), and a poor outcome, defined as restoration of neither BMI nor menses (from 33% to 12%).

The frequency of 3 of 10 eating-disordered behaviors–bingeing, vomiting, and laxative use–was significantly higher at postgraduate follow-up than at discharge. “This is not terribly surprising,” Dr. Brewerton said at the conference, which was cosponsored by the University of New Mexico. Moreover, the values remained significantly or marginally lower than those at admission.

Scores on the BDI decreased significantly between admission and discharge, and remained so at postgraduate follow-up. About 85% of patients reported that they were improved or significantly improved at the latter assessment.

Turning to the bulimia group, Dr. Brewerton reported that these patients had significant improvements in all 11 EDI-2 subscales by discharge, and the benefits persisted to postgraduate follow-up. Their BMIs were in the normal range at all three assessments.

Between discharge and postgraduate follow-up, there was a decrease in the percentage of bulimic patients with a good outcome, defined as complete cessation of bingeing, purging, and other compensatory behaviors (from 97% to 62%) and an increase in the percentages with an intermediate outcome, defined as a reduction in those behaviors by at least half (from 3% to 19%), and a poor outcome, defined as a reduction of less than half (from 0% to 19%).

The frequency of 7 of the 10 eating-disordered behaviors decreased significantly by discharge and remained at that level at the postgraduate follow-up. As in the group with anorexia, BDI scores fell by discharge in this group and remained at this level thereafter. Similarly, about 85% of patients reported themselves to be improved or significantly improved.

“The great majority of clients in this program showed significant improvement at long-term follow-up after intensive residential care,” Dr. Brewerton said, while noting that receipt of therapy during follow-up is still being analyzed. He observed that many of the patients entering the program had treatment-refractory eating disorders and had previously received care as inpatients or outpatients, or in other residential programs.

“Residential treatment using this particular treatment philosophy can be an effective and less costly alternative to inpatient treatment,” he concluded. He said this philosophy is best described in The Eating Disorder Sourcebook (New York: McGraw-Hill, 2007), by Carolyn Costin. Ms. Costin is the founder and director of the Monte Nido Residential Treatment Program, the program studied. Dr. Brewerton reported that he was paid as a consultant by Monte Nido to collate, analyze, and present the survey data.

'Residential treatment … can be an effective and less costly alternative to inpatient treatment.' DR. BREWERTON

SEATTLE – Initial improvements in anorexia nervosa and bulimia nervosa achieved in an intensive residential treatment program are largely sustained 4-5 years later, Dr. Timothy D. Brewerton reported.

“Data on long-term follow-up of individuals with anorexia nervosa and bulimia nervosa following intensive inpatient or residential treatment are limited,” said Dr. Brewerton, a psychiatrist at the Medical University of South Carolina, Charleston, who also is in private practice in Mt. Pleasant, S.C. “Many studies are primarily on adolescents and/or outpatients, and others have included individuals who have not received any treatment.”

The investigators surveyed patients with eating disorders who had received at least 30 days of treatment in a residential program in Malibu, Calif. Outcomes on the Eating Disorder Inventory-2 (EDI-2), the Beck Depression Inventory (BDI), and a structured eating disorder assessment were evaluated at three time points: admission, discharge, and the most recent of 13 postgraduate follow-ups, which ranged from 1 to 10 years.

Analyses were based on 85 patients with anorexia and 71 patients with bulimia. The mean time between discharge and postgraduate follow-up was 4.5 and 4.1 years, respectively. On average, the patients in each group were about 30 years old (range, 17-57).

In the anorexia group, mean BMI scores (reported by a physician, therapist, or dietician) increased significantly between admission and discharge (from 16 to 18), Dr. Brewerton told those attending an international conference sponsored by the Academy for Eating Disorders. Moreover, a further significant increase was seen from discharge to postgraduate follow-up (from 18 to 19).

By discharge, the patients with anorexia had significant improvements in 9 of 11 subscales of the EDI-2. They had further significant improvements in five of the subscales–drive for thinness, body dissatisfaction, interoceptive awareness, maturity fears, and asceticism–between discharge and postgraduate follow-up.

The percentage of anorexia patients with a good outcome, defined as a return of body mass index (BMI) to at least 18 and normal menses, increased between discharge and postgraduate follow-up (from 19% to 41%). At the same time, there was a decrease in the percentages with an intermediate outcome, defined as restoration of BMI or normal menses (from 48% to 46%), and a poor outcome, defined as restoration of neither BMI nor menses (from 33% to 12%).

The frequency of 3 of 10 eating-disordered behaviors–bingeing, vomiting, and laxative use–was significantly higher at postgraduate follow-up than at discharge. “This is not terribly surprising,” Dr. Brewerton said at the conference, which was cosponsored by the University of New Mexico. Moreover, the values remained significantly or marginally lower than those at admission.

Scores on the BDI decreased significantly between admission and discharge, and remained so at postgraduate follow-up. About 85% of patients reported that they were improved or significantly improved at the latter assessment.

Turning to the bulimia group, Dr. Brewerton reported that these patients had significant improvements in all 11 EDI-2 subscales by discharge, and the benefits persisted to postgraduate follow-up. Their BMIs were in the normal range at all three assessments.

Between discharge and postgraduate follow-up, there was a decrease in the percentage of bulimic patients with a good outcome, defined as complete cessation of bingeing, purging, and other compensatory behaviors (from 97% to 62%) and an increase in the percentages with an intermediate outcome, defined as a reduction in those behaviors by at least half (from 3% to 19%), and a poor outcome, defined as a reduction of less than half (from 0% to 19%).

The frequency of 7 of the 10 eating-disordered behaviors decreased significantly by discharge and remained at that level at the postgraduate follow-up. As in the group with anorexia, BDI scores fell by discharge in this group and remained at this level thereafter. Similarly, about 85% of patients reported themselves to be improved or significantly improved.

“The great majority of clients in this program showed significant improvement at long-term follow-up after intensive residential care,” Dr. Brewerton said, while noting that receipt of therapy during follow-up is still being analyzed. He observed that many of the patients entering the program had treatment-refractory eating disorders and had previously received care as inpatients or outpatients, or in other residential programs.

“Residential treatment using this particular treatment philosophy can be an effective and less costly alternative to inpatient treatment,” he concluded. He said this philosophy is best described in The Eating Disorder Sourcebook (New York: McGraw-Hill, 2007), by Carolyn Costin. Ms. Costin is the founder and director of the Monte Nido Residential Treatment Program, the program studied. Dr. Brewerton reported that he was paid as a consultant by Monte Nido to collate, analyze, and present the survey data.

'Residential treatment … can be an effective and less costly alternative to inpatient treatment.' DR. BREWERTON

SEATTLE – Initial improvements in anorexia nervosa and bulimia nervosa achieved in an intensive residential treatment program are largely sustained 4-5 years later, Dr. Timothy D. Brewerton reported.

“Data on long-term follow-up of individuals with anorexia nervosa and bulimia nervosa following intensive inpatient or residential treatment are limited,” said Dr. Brewerton, a psychiatrist at the Medical University of South Carolina, Charleston, who also is in private practice in Mt. Pleasant, S.C. “Many studies are primarily on adolescents and/or outpatients, and others have included individuals who have not received any treatment.”

The investigators surveyed patients with eating disorders who had received at least 30 days of treatment in a residential program in Malibu, Calif. Outcomes on the Eating Disorder Inventory-2 (EDI-2), the Beck Depression Inventory (BDI), and a structured eating disorder assessment were evaluated at three time points: admission, discharge, and the most recent of 13 postgraduate follow-ups, which ranged from 1 to 10 years.

Analyses were based on 85 patients with anorexia and 71 patients with bulimia. The mean time between discharge and postgraduate follow-up was 4.5 and 4.1 years, respectively. On average, the patients in each group were about 30 years old (range, 17-57).

In the anorexia group, mean BMI scores (reported by a physician, therapist, or dietician) increased significantly between admission and discharge (from 16 to 18), Dr. Brewerton told those attending an international conference sponsored by the Academy for Eating Disorders. Moreover, a further significant increase was seen from discharge to postgraduate follow-up (from 18 to 19).

By discharge, the patients with anorexia had significant improvements in 9 of 11 subscales of the EDI-2. They had further significant improvements in five of the subscales–drive for thinness, body dissatisfaction, interoceptive awareness, maturity fears, and asceticism–between discharge and postgraduate follow-up.

The percentage of anorexia patients with a good outcome, defined as a return of body mass index (BMI) to at least 18 and normal menses, increased between discharge and postgraduate follow-up (from 19% to 41%). At the same time, there was a decrease in the percentages with an intermediate outcome, defined as restoration of BMI or normal menses (from 48% to 46%), and a poor outcome, defined as restoration of neither BMI nor menses (from 33% to 12%).

The frequency of 3 of 10 eating-disordered behaviors–bingeing, vomiting, and laxative use–was significantly higher at postgraduate follow-up than at discharge. “This is not terribly surprising,” Dr. Brewerton said at the conference, which was cosponsored by the University of New Mexico. Moreover, the values remained significantly or marginally lower than those at admission.

Scores on the BDI decreased significantly between admission and discharge, and remained so at postgraduate follow-up. About 85% of patients reported that they were improved or significantly improved at the latter assessment.

Turning to the bulimia group, Dr. Brewerton reported that these patients had significant improvements in all 11 EDI-2 subscales by discharge, and the benefits persisted to postgraduate follow-up. Their BMIs were in the normal range at all three assessments.

Between discharge and postgraduate follow-up, there was a decrease in the percentage of bulimic patients with a good outcome, defined as complete cessation of bingeing, purging, and other compensatory behaviors (from 97% to 62%) and an increase in the percentages with an intermediate outcome, defined as a reduction in those behaviors by at least half (from 3% to 19%), and a poor outcome, defined as a reduction of less than half (from 0% to 19%).

The frequency of 7 of the 10 eating-disordered behaviors decreased significantly by discharge and remained at that level at the postgraduate follow-up. As in the group with anorexia, BDI scores fell by discharge in this group and remained at this level thereafter. Similarly, about 85% of patients reported themselves to be improved or significantly improved.

“The great majority of clients in this program showed significant improvement at long-term follow-up after intensive residential care,” Dr. Brewerton said, while noting that receipt of therapy during follow-up is still being analyzed. He observed that many of the patients entering the program had treatment-refractory eating disorders and had previously received care as inpatients or outpatients, or in other residential programs.

“Residential treatment using this particular treatment philosophy can be an effective and less costly alternative to inpatient treatment,” he concluded. He said this philosophy is best described in The Eating Disorder Sourcebook (New York: McGraw-Hill, 2007), by Carolyn Costin. Ms. Costin is the founder and director of the Monte Nido Residential Treatment Program, the program studied. Dr. Brewerton reported that he was paid as a consultant by Monte Nido to collate, analyze, and present the survey data.

'Residential treatment … can be an effective and less costly alternative to inpatient treatment.' DR. BREWERTON

SEATTLE – Money and time are the leading barriers to seeking weight-loss treatment among overweight and obese adults, but stigma and a belief that one is too heavy for treatment become more influential barriers as people get heavier.

Little is known from the literature about patterns of treatment seeking for obesity over time, Anna C. Ciao said at an international conference sponsored by the Academy for Eating Disorders. She also said little is known about barriers that might prevent treatment seeking from taking place.

An anonymous online survey offered to overweight or obese men and women aged 18 years or older addressed some of these issues, according to Ms. Ciao, a graduate student at the University of Hawaii, Honolulu.

The survey asked about seven treatments of increasing intensity (based on level of professional involvement): treatment on one's own by taking steps such as reducing caloric intake, reading self-help books, using self-help online programs, turning to commercial programs such as Weight Watchers, seeking help from professionals other than medical doctors such as nutritionists and psychotherapists, turning to medical doctors, and having weight-loss surgery.

The survey also asked about five barriers to seeking treatment: money, time, stigma, shame, and a belief that one is too heavy for the treatment.

Of the 154 respondents, 76% were white, 16% were black, 2% were Hispanic, and the rest were of other or mixed ethnicities, Ms. Ciao said at the conference, cosponsored by the University of New Mexico. Eighty-six percent were women. The respondents' mean age was 30 years (range was 18-67 years). Their mean body mass index (BMI) was 33 kg/m

Among the seven treatments, treatment on one's own was the most commonly sought, desired, and planned. Overall, 77% of respondents had sought this treatment; 36% desired it but had no current plans, and 51% planned to pursue it in the near future. In contrast, surgery was the least commonly sought (8%), desired (18%), and planned (8%) treatment.

“Despite these high levels of endorsement of treatment seeking, a substantial number of people did not say yes to seeking any kind of treatment,” Ms. Ciao said. Eleven percent had not sought any of the treatments; in addition, 28% did not desire any, and 25% had no plans for any. However, she noted, respondents were limited to the treatments listed on the survey.

Of the five barriers to treatment, the most commonly cited overall was money, and the second most commonly cited was not having enough time. “In general, money and time were cited as barriers for the more intensive types of treatments, like commercial programs, other professionals, and medical doctors,” Ms. Ciao said. Most respondents reported no barriers to three less-intensive treatments: treatment on one's own, self-help online programs, and self-help books.

BMI was correlated with the total number of treatments sought but not with the number desired or planned.

“Heavier people sought a greater number of treatments in the past but didn't necessarily plan to seek or desire to seek more treatments in the future,” Ms. Ciao said. That disconnect might suggest “suggest some discouragement from the failed weight-loss attempt,” she said.

BMI also was correlated with the total number of barriers across treatments, indicating that heavier people perceive more barriers to treatment generally, she said. Moreover, BMI was correlated with stigma and being too heavy for treatment individually. “Feeling too heavy may reflect a sort of anticipated failure or an expectation that weight-loss treatment may not work for them,” Ms. Ciao said.

Ms. Ciao reported that she had no conflicts of interest in association with the study.

'Feeling too heavy may reflect … an expectation that weight-loss treatment may not work for them.' MS. CIAO

SEATTLE – Money and time are the leading barriers to seeking weight-loss treatment among overweight and obese adults, but stigma and a belief that one is too heavy for treatment become more influential barriers as people get heavier.

Little is known from the literature about patterns of treatment seeking for obesity over time, Anna C. Ciao said at an international conference sponsored by the Academy for Eating Disorders. She also said little is known about barriers that might prevent treatment seeking from taking place.

An anonymous online survey offered to overweight or obese men and women aged 18 years or older addressed some of these issues, according to Ms. Ciao, a graduate student at the University of Hawaii, Honolulu.

The survey asked about seven treatments of increasing intensity (based on level of professional involvement): treatment on one's own by taking steps such as reducing caloric intake, reading self-help books, using self-help online programs, turning to commercial programs such as Weight Watchers, seeking help from professionals other than medical doctors such as nutritionists and psychotherapists, turning to medical doctors, and having weight-loss surgery.

The survey also asked about five barriers to seeking treatment: money, time, stigma, shame, and a belief that one is too heavy for the treatment.

Of the 154 respondents, 76% were white, 16% were black, 2% were Hispanic, and the rest were of other or mixed ethnicities, Ms. Ciao said at the conference, cosponsored by the University of New Mexico. Eighty-six percent were women. The respondents' mean age was 30 years (range was 18-67 years). Their mean body mass index (BMI) was 33 kg/m

Among the seven treatments, treatment on one's own was the most commonly sought, desired, and planned. Overall, 77% of respondents had sought this treatment; 36% desired it but had no current plans, and 51% planned to pursue it in the near future. In contrast, surgery was the least commonly sought (8%), desired (18%), and planned (8%) treatment.

“Despite these high levels of endorsement of treatment seeking, a substantial number of people did not say yes to seeking any kind of treatment,” Ms. Ciao said. Eleven percent had not sought any of the treatments; in addition, 28% did not desire any, and 25% had no plans for any. However, she noted, respondents were limited to the treatments listed on the survey.

Of the five barriers to treatment, the most commonly cited overall was money, and the second most commonly cited was not having enough time. “In general, money and time were cited as barriers for the more intensive types of treatments, like commercial programs, other professionals, and medical doctors,” Ms. Ciao said. Most respondents reported no barriers to three less-intensive treatments: treatment on one's own, self-help online programs, and self-help books.

BMI was correlated with the total number of treatments sought but not with the number desired or planned.

“Heavier people sought a greater number of treatments in the past but didn't necessarily plan to seek or desire to seek more treatments in the future,” Ms. Ciao said. That disconnect might suggest “suggest some discouragement from the failed weight-loss attempt,” she said.

BMI also was correlated with the total number of barriers across treatments, indicating that heavier people perceive more barriers to treatment generally, she said. Moreover, BMI was correlated with stigma and being too heavy for treatment individually. “Feeling too heavy may reflect a sort of anticipated failure or an expectation that weight-loss treatment may not work for them,” Ms. Ciao said.

Ms. Ciao reported that she had no conflicts of interest in association with the study.

'Feeling too heavy may reflect … an expectation that weight-loss treatment may not work for them.' MS. CIAO

SEATTLE – Money and time are the leading barriers to seeking weight-loss treatment among overweight and obese adults, but stigma and a belief that one is too heavy for treatment become more influential barriers as people get heavier.

Little is known from the literature about patterns of treatment seeking for obesity over time, Anna C. Ciao said at an international conference sponsored by the Academy for Eating Disorders. She also said little is known about barriers that might prevent treatment seeking from taking place.

An anonymous online survey offered to overweight or obese men and women aged 18 years or older addressed some of these issues, according to Ms. Ciao, a graduate student at the University of Hawaii, Honolulu.

The survey asked about seven treatments of increasing intensity (based on level of professional involvement): treatment on one's own by taking steps such as reducing caloric intake, reading self-help books, using self-help online programs, turning to commercial programs such as Weight Watchers, seeking help from professionals other than medical doctors such as nutritionists and psychotherapists, turning to medical doctors, and having weight-loss surgery.

The survey also asked about five barriers to seeking treatment: money, time, stigma, shame, and a belief that one is too heavy for the treatment.

Of the 154 respondents, 76% were white, 16% were black, 2% were Hispanic, and the rest were of other or mixed ethnicities, Ms. Ciao said at the conference, cosponsored by the University of New Mexico. Eighty-six percent were women. The respondents' mean age was 30 years (range was 18-67 years). Their mean body mass index (BMI) was 33 kg/m

Among the seven treatments, treatment on one's own was the most commonly sought, desired, and planned. Overall, 77% of respondents had sought this treatment; 36% desired it but had no current plans, and 51% planned to pursue it in the near future. In contrast, surgery was the least commonly sought (8%), desired (18%), and planned (8%) treatment.

“Despite these high levels of endorsement of treatment seeking, a substantial number of people did not say yes to seeking any kind of treatment,” Ms. Ciao said. Eleven percent had not sought any of the treatments; in addition, 28% did not desire any, and 25% had no plans for any. However, she noted, respondents were limited to the treatments listed on the survey.

Of the five barriers to treatment, the most commonly cited overall was money, and the second most commonly cited was not having enough time. “In general, money and time were cited as barriers for the more intensive types of treatments, like commercial programs, other professionals, and medical doctors,” Ms. Ciao said. Most respondents reported no barriers to three less-intensive treatments: treatment on one's own, self-help online programs, and self-help books.

BMI was correlated with the total number of treatments sought but not with the number desired or planned.

“Heavier people sought a greater number of treatments in the past but didn't necessarily plan to seek or desire to seek more treatments in the future,” Ms. Ciao said. That disconnect might suggest “suggest some discouragement from the failed weight-loss attempt,” she said.

BMI also was correlated with the total number of barriers across treatments, indicating that heavier people perceive more barriers to treatment generally, she said. Moreover, BMI was correlated with stigma and being too heavy for treatment individually. “Feeling too heavy may reflect a sort of anticipated failure or an expectation that weight-loss treatment may not work for them,” Ms. Ciao said.

Ms. Ciao reported that she had no conflicts of interest in association with the study.

'Feeling too heavy may reflect … an expectation that weight-loss treatment may not work for them.' MS. CIAO

SEATTLE – The predictive utility of a rapid response to treatment for binge eating disorder and obesity depends on the type of treatment, a randomized, controlled trial shows.

It also is important to identify predictors, because many patients with binge eating disorder do not remit from the binge eating and many fail to lose weight, lead author Carlos M. Grilo, Ph.D., reported at an international conference sponsored by the Academy for Eating Disorders.

Efforts aimed at identifying conventional predictors have met with little success. A different approach might be to look at patients' treatment response rather than at their characteristics before treatment, said Dr. Grilo, director of the Eating Disorders and Obesity Research Program at Yale University, New Haven, Conn.

In a randomized, controlled trial among 125 obese patients with binge eating disorder, the investigators compared 6 months of behavioral weight loss therapy (BWL), 6 months of cognitive-behavioral therapy (CBT), and a combination of 4 months of CBT followed by 6 months of BWL. Patients were weighed biweekly. Binge eating frequency was assessed from self-reports and from the Eating Disorders Examination Interview, administered at baseline, end of treatment, and 6 and 12 months thereafter, said Dr. Grilo, also a professor of psychiatry and psychology at Yale.

The patients were 44 years old on average, and 68% were women, Dr. Grilo reported at the conference, which was cosponsored by the University of New Mexico. Fully 70% had Axis I diagnoses, and 27% had Axis II diagnoses. The mean body mass index was 39 kg/m

Analyses focusing on the two monotherapy groups showed that 47% of patients assigned to BWL and 67% of patients assigned to CBT had a rapid response to treatment–defined as a reduction in the number of binge episodes by at least 70% during the first 4 weeks of treatment.

In the BWL group, the percentage of patients in binge remission (meaning they had no bingeing episodes in the previous month) increased in the year after treatment among rapid responders but remained unchanged among non-rapid responders. At each assessment (end of treatment, 6 months, 12 months), the remission rate was significantly higher among the former group, with a difference at 12 months of about 68% vs. 18%.

In the CBT group, the percentage of patients in remission remained stable in the year after treatment among rapid responders and increased among non-rapid responders, with about 70% and 53%, respectively, in remission at 12 months.

As a result, the remission rate was significantly higher in the rapidly responding subset only at the end of treatment, a pattern that may reflect a “catching up” among those without a rapid response, Dr. Grilo speculated.

When it came to weight loss, the change in body mass index for the BWL group was significantly greater among rapid responders than among non-rapid responders at each assessment, with a reduction of 4% vs. 0% at 12 months. Dr. Grilo characterized this as an exciting finding given the difficulty of achieving weight loss in this population.

In contrast, in the CBT group, no difference in this outcome was found according to speed of response. “Quite frankly, whether you had a rapid response to CBT or not didn't matter, because you really didn't lose much weight,” he said.

“Clinically, we think that the findings suggest that binge eating patients who respond rapidly may have the best potential outcome with behavioral weight loss, because they may be more likely to remit from binge eating plus they may actually lose weight,” Dr. Grilo asserted.

Dr. Grilo reported that he had no conflicts of interest in association with the study.

'Whether you had a rapid response to CBT or not didn't matter, because you really didn't lose much weight.' DR. GRILO

SEATTLE – The predictive utility of a rapid response to treatment for binge eating disorder and obesity depends on the type of treatment, a randomized, controlled trial shows.

It also is important to identify predictors, because many patients with binge eating disorder do not remit from the binge eating and many fail to lose weight, lead author Carlos M. Grilo, Ph.D., reported at an international conference sponsored by the Academy for Eating Disorders.

Efforts aimed at identifying conventional predictors have met with little success. A different approach might be to look at patients' treatment response rather than at their characteristics before treatment, said Dr. Grilo, director of the Eating Disorders and Obesity Research Program at Yale University, New Haven, Conn.

In a randomized, controlled trial among 125 obese patients with binge eating disorder, the investigators compared 6 months of behavioral weight loss therapy (BWL), 6 months of cognitive-behavioral therapy (CBT), and a combination of 4 months of CBT followed by 6 months of BWL. Patients were weighed biweekly. Binge eating frequency was assessed from self-reports and from the Eating Disorders Examination Interview, administered at baseline, end of treatment, and 6 and 12 months thereafter, said Dr. Grilo, also a professor of psychiatry and psychology at Yale.

The patients were 44 years old on average, and 68% were women, Dr. Grilo reported at the conference, which was cosponsored by the University of New Mexico. Fully 70% had Axis I diagnoses, and 27% had Axis II diagnoses. The mean body mass index was 39 kg/m

Analyses focusing on the two monotherapy groups showed that 47% of patients assigned to BWL and 67% of patients assigned to CBT had a rapid response to treatment–defined as a reduction in the number of binge episodes by at least 70% during the first 4 weeks of treatment.

In the BWL group, the percentage of patients in binge remission (meaning they had no bingeing episodes in the previous month) increased in the year after treatment among rapid responders but remained unchanged among non-rapid responders. At each assessment (end of treatment, 6 months, 12 months), the remission rate was significantly higher among the former group, with a difference at 12 months of about 68% vs. 18%.

In the CBT group, the percentage of patients in remission remained stable in the year after treatment among rapid responders and increased among non-rapid responders, with about 70% and 53%, respectively, in remission at 12 months.

As a result, the remission rate was significantly higher in the rapidly responding subset only at the end of treatment, a pattern that may reflect a “catching up” among those without a rapid response, Dr. Grilo speculated.

When it came to weight loss, the change in body mass index for the BWL group was significantly greater among rapid responders than among non-rapid responders at each assessment, with a reduction of 4% vs. 0% at 12 months. Dr. Grilo characterized this as an exciting finding given the difficulty of achieving weight loss in this population.

In contrast, in the CBT group, no difference in this outcome was found according to speed of response. “Quite frankly, whether you had a rapid response to CBT or not didn't matter, because you really didn't lose much weight,” he said.

“Clinically, we think that the findings suggest that binge eating patients who respond rapidly may have the best potential outcome with behavioral weight loss, because they may be more likely to remit from binge eating plus they may actually lose weight,” Dr. Grilo asserted.

Dr. Grilo reported that he had no conflicts of interest in association with the study.

'Whether you had a rapid response to CBT or not didn't matter, because you really didn't lose much weight.' DR. GRILO

SEATTLE – The predictive utility of a rapid response to treatment for binge eating disorder and obesity depends on the type of treatment, a randomized, controlled trial shows.

It also is important to identify predictors, because many patients with binge eating disorder do not remit from the binge eating and many fail to lose weight, lead author Carlos M. Grilo, Ph.D., reported at an international conference sponsored by the Academy for Eating Disorders.

Efforts aimed at identifying conventional predictors have met with little success. A different approach might be to look at patients' treatment response rather than at their characteristics before treatment, said Dr. Grilo, director of the Eating Disorders and Obesity Research Program at Yale University, New Haven, Conn.

In a randomized, controlled trial among 125 obese patients with binge eating disorder, the investigators compared 6 months of behavioral weight loss therapy (BWL), 6 months of cognitive-behavioral therapy (CBT), and a combination of 4 months of CBT followed by 6 months of BWL. Patients were weighed biweekly. Binge eating frequency was assessed from self-reports and from the Eating Disorders Examination Interview, administered at baseline, end of treatment, and 6 and 12 months thereafter, said Dr. Grilo, also a professor of psychiatry and psychology at Yale.

The patients were 44 years old on average, and 68% were women, Dr. Grilo reported at the conference, which was cosponsored by the University of New Mexico. Fully 70% had Axis I diagnoses, and 27% had Axis II diagnoses. The mean body mass index was 39 kg/m

Analyses focusing on the two monotherapy groups showed that 47% of patients assigned to BWL and 67% of patients assigned to CBT had a rapid response to treatment–defined as a reduction in the number of binge episodes by at least 70% during the first 4 weeks of treatment.

In the BWL group, the percentage of patients in binge remission (meaning they had no bingeing episodes in the previous month) increased in the year after treatment among rapid responders but remained unchanged among non-rapid responders. At each assessment (end of treatment, 6 months, 12 months), the remission rate was significantly higher among the former group, with a difference at 12 months of about 68% vs. 18%.

In the CBT group, the percentage of patients in remission remained stable in the year after treatment among rapid responders and increased among non-rapid responders, with about 70% and 53%, respectively, in remission at 12 months.

As a result, the remission rate was significantly higher in the rapidly responding subset only at the end of treatment, a pattern that may reflect a “catching up” among those without a rapid response, Dr. Grilo speculated.

When it came to weight loss, the change in body mass index for the BWL group was significantly greater among rapid responders than among non-rapid responders at each assessment, with a reduction of 4% vs. 0% at 12 months. Dr. Grilo characterized this as an exciting finding given the difficulty of achieving weight loss in this population.

In contrast, in the CBT group, no difference in this outcome was found according to speed of response. “Quite frankly, whether you had a rapid response to CBT or not didn't matter, because you really didn't lose much weight,” he said.

“Clinically, we think that the findings suggest that binge eating patients who respond rapidly may have the best potential outcome with behavioral weight loss, because they may be more likely to remit from binge eating plus they may actually lose weight,” Dr. Grilo asserted.

Dr. Grilo reported that he had no conflicts of interest in association with the study.

'Whether you had a rapid response to CBT or not didn't matter, because you really didn't lose much weight.' DR. GRILO

SEATTLE – Sizable proportions of adolescents progress along a spectrum of eating-disordered behavior over time, highlighting the importance of early detection and intervention, Diann M. Ackard, Ph.D., said at an international conference sponsored by the Academy for Eating Disorders.

“The percentage of disordered eating behaviors in epidemiological samples of youth has been actually pretty varied,” said Dr. Ackard, a psychologist in private practice in Golden Valley, Minn., explaining part of the study's rationale. In addition, she noted, data also suggest that some young people who report eating disorder symptoms worsen over time, developing partial- or full-syndrome disorders.

Dr. Ackard and her colleagues assessed the stability of eating disorder classifications among a population-based sample of adolescents in Project EAT (Eating Among Teens). In the project, the same adolescents completed surveys about eating behaviors and body image in 1999 and again in 2004, and the survey items were mapped onto DSM-IV criteria.

Analyses were based on 2,516 adolescents in middle school or high school at the first assessment, Dr. Ackard reported at the conference, which was cosponsored by the University of New Mexico. Those in middle school were a mean age of 12.8 years and those in high school were a mean age of 15.8 years in 1999. Fifty-five percent were female.

At the first assessment, 10% of adolescents met full-threshold criteria for an eating disorder (anorexia nervosa, bulimia nervosa, or binge eating), 39% had some subthreshold symptoms (compensatory behaviors or body image disturbance), and 50% were asymptomatic.

Five years later, considerable flux in the eating disorder groups was evident, Dr. Ackard reported. Among female adolescents who were asymptomatic at the first assessment, 63% remained so at follow-up–but 36% had developed symptoms and 1% had developed full clinical disorders. About 61% of those who initially had some symptoms still had them; another 37% had improved, becoming asymptomatic, but 3% had worsened and developed clinical disorders.

Only 10% of female adolescents who initially had clinical disorders still had them; fully 70% had a reduction in severity to some symptoms and 20% were now symptom free. “We are not sure as to whether that was a treatment-seeking sample or if they naturally remitted,” Dr. Ackard noted of the last group, because the survey did not ask about treatment.

Among male adolescents who were asymptomatic at the first assessment, 74.5% remained so at the second assessment, but 25% had developed some symptoms and 0.4% had developed clinical disorders. And 38.8% of those who initially had some symptoms still had them; an additional 59.9% no longer had any symptoms, but 1.4% had progressed to a clinical disorder. Finally, all of the male adolescents who initially had a clinical disorder had improved to the point of having only some symptoms.

The study's good news, Dr. Ackard said, is that after 5 years, most asymptomatic youth (68.9% overall) remained symptom free, most with subclinical symptoms (52.4%) did not worsen to full clinical eating disorders and in fact 45.2% became asymptomatic.

In addition, most with clinical eating disorders improved to having only some subclinical symptoms (74%) or no symptoms (18%), said Dr. Ackard, also of the University of Minnesota, Minneapolis, and a research scientist at the Eating Disorders Institute at Park Nicollet Methodist Hospital, St. Louis Park, Minn.

On the flip side, some asymptomatic adolescents worsened to the point of having subclinical symptoms (30%) or clinical disorders (1%), others with symptoms progress to clinical disorders (2%), and a considerable proportion with clinical disorders still had them 5 years later (9%).

“I think for me what this means is early detection of eating disorder symptoms before meeting full-threshold eating disorder criteria is important for early intervention,” Dr. Ackard said, noting that she favors insurance coverage of treatment for youth who do not yet meet full criteria.

In addition, she said, early treatment intervention might keep some young people from progressing to symptoms of greater severity.

“I am a vast proponent of broad, intensive prevention and treatment interventions particularly among youth, and even among youth who are younger than this particular sample we surveyed in this study, because I think everybody in the room is very aware that we see early signs of eating disorders even among 5-, 6-, 7-, and 8-year-olds,” Dr. Ackard said.

She reported that she had no conflicts of interest in association with the study.

Five years after first assessment, considerable flux in the eating disorder groups was evident. DR. ACKARD

SEATTLE – Sizable proportions of adolescents progress along a spectrum of eating-disordered behavior over time, highlighting the importance of early detection and intervention, Diann M. Ackard, Ph.D., said at an international conference sponsored by the Academy for Eating Disorders.

“The percentage of disordered eating behaviors in epidemiological samples of youth has been actually pretty varied,” said Dr. Ackard, a psychologist in private practice in Golden Valley, Minn., explaining part of the study's rationale. In addition, she noted, data also suggest that some young people who report eating disorder symptoms worsen over time, developing partial- or full-syndrome disorders.

Dr. Ackard and her colleagues assessed the stability of eating disorder classifications among a population-based sample of adolescents in Project EAT (Eating Among Teens). In the project, the same adolescents completed surveys about eating behaviors and body image in 1999 and again in 2004, and the survey items were mapped onto DSM-IV criteria.

Analyses were based on 2,516 adolescents in middle school or high school at the first assessment, Dr. Ackard reported at the conference, which was cosponsored by the University of New Mexico. Those in middle school were a mean age of 12.8 years and those in high school were a mean age of 15.8 years in 1999. Fifty-five percent were female.

At the first assessment, 10% of adolescents met full-threshold criteria for an eating disorder (anorexia nervosa, bulimia nervosa, or binge eating), 39% had some subthreshold symptoms (compensatory behaviors or body image disturbance), and 50% were asymptomatic.

Five years later, considerable flux in the eating disorder groups was evident, Dr. Ackard reported. Among female adolescents who were asymptomatic at the first assessment, 63% remained so at follow-up–but 36% had developed symptoms and 1% had developed full clinical disorders. About 61% of those who initially had some symptoms still had them; another 37% had improved, becoming asymptomatic, but 3% had worsened and developed clinical disorders.

Only 10% of female adolescents who initially had clinical disorders still had them; fully 70% had a reduction in severity to some symptoms and 20% were now symptom free. “We are not sure as to whether that was a treatment-seeking sample or if they naturally remitted,” Dr. Ackard noted of the last group, because the survey did not ask about treatment.

Among male adolescents who were asymptomatic at the first assessment, 74.5% remained so at the second assessment, but 25% had developed some symptoms and 0.4% had developed clinical disorders. And 38.8% of those who initially had some symptoms still had them; an additional 59.9% no longer had any symptoms, but 1.4% had progressed to a clinical disorder. Finally, all of the male adolescents who initially had a clinical disorder had improved to the point of having only some symptoms.

The study's good news, Dr. Ackard said, is that after 5 years, most asymptomatic youth (68.9% overall) remained symptom free, most with subclinical symptoms (52.4%) did not worsen to full clinical eating disorders and in fact 45.2% became asymptomatic.

In addition, most with clinical eating disorders improved to having only some subclinical symptoms (74%) or no symptoms (18%), said Dr. Ackard, also of the University of Minnesota, Minneapolis, and a research scientist at the Eating Disorders Institute at Park Nicollet Methodist Hospital, St. Louis Park, Minn.

On the flip side, some asymptomatic adolescents worsened to the point of having subclinical symptoms (30%) or clinical disorders (1%), others with symptoms progress to clinical disorders (2%), and a considerable proportion with clinical disorders still had them 5 years later (9%).

“I think for me what this means is early detection of eating disorder symptoms before meeting full-threshold eating disorder criteria is important for early intervention,” Dr. Ackard said, noting that she favors insurance coverage of treatment for youth who do not yet meet full criteria.

In addition, she said, early treatment intervention might keep some young people from progressing to symptoms of greater severity.

“I am a vast proponent of broad, intensive prevention and treatment interventions particularly among youth, and even among youth who are younger than this particular sample we surveyed in this study, because I think everybody in the room is very aware that we see early signs of eating disorders even among 5-, 6-, 7-, and 8-year-olds,” Dr. Ackard said.

She reported that she had no conflicts of interest in association with the study.

Five years after first assessment, considerable flux in the eating disorder groups was evident. DR. ACKARD

SEATTLE – Sizable proportions of adolescents progress along a spectrum of eating-disordered behavior over time, highlighting the importance of early detection and intervention, Diann M. Ackard, Ph.D., said at an international conference sponsored by the Academy for Eating Disorders.

“The percentage of disordered eating behaviors in epidemiological samples of youth has been actually pretty varied,” said Dr. Ackard, a psychologist in private practice in Golden Valley, Minn., explaining part of the study's rationale. In addition, she noted, data also suggest that some young people who report eating disorder symptoms worsen over time, developing partial- or full-syndrome disorders.

Dr. Ackard and her colleagues assessed the stability of eating disorder classifications among a population-based sample of adolescents in Project EAT (Eating Among Teens). In the project, the same adolescents completed surveys about eating behaviors and body image in 1999 and again in 2004, and the survey items were mapped onto DSM-IV criteria.

Analyses were based on 2,516 adolescents in middle school or high school at the first assessment, Dr. Ackard reported at the conference, which was cosponsored by the University of New Mexico. Those in middle school were a mean age of 12.8 years and those in high school were a mean age of 15.8 years in 1999. Fifty-five percent were female.

At the first assessment, 10% of adolescents met full-threshold criteria for an eating disorder (anorexia nervosa, bulimia nervosa, or binge eating), 39% had some subthreshold symptoms (compensatory behaviors or body image disturbance), and 50% were asymptomatic.

Five years later, considerable flux in the eating disorder groups was evident, Dr. Ackard reported. Among female adolescents who were asymptomatic at the first assessment, 63% remained so at follow-up–but 36% had developed symptoms and 1% had developed full clinical disorders. About 61% of those who initially had some symptoms still had them; another 37% had improved, becoming asymptomatic, but 3% had worsened and developed clinical disorders.

Only 10% of female adolescents who initially had clinical disorders still had them; fully 70% had a reduction in severity to some symptoms and 20% were now symptom free. “We are not sure as to whether that was a treatment-seeking sample or if they naturally remitted,” Dr. Ackard noted of the last group, because the survey did not ask about treatment.

Among male adolescents who were asymptomatic at the first assessment, 74.5% remained so at the second assessment, but 25% had developed some symptoms and 0.4% had developed clinical disorders. And 38.8% of those who initially had some symptoms still had them; an additional 59.9% no longer had any symptoms, but 1.4% had progressed to a clinical disorder. Finally, all of the male adolescents who initially had a clinical disorder had improved to the point of having only some symptoms.

The study's good news, Dr. Ackard said, is that after 5 years, most asymptomatic youth (68.9% overall) remained symptom free, most with subclinical symptoms (52.4%) did not worsen to full clinical eating disorders and in fact 45.2% became asymptomatic.

In addition, most with clinical eating disorders improved to having only some subclinical symptoms (74%) or no symptoms (18%), said Dr. Ackard, also of the University of Minnesota, Minneapolis, and a research scientist at the Eating Disorders Institute at Park Nicollet Methodist Hospital, St. Louis Park, Minn.

On the flip side, some asymptomatic adolescents worsened to the point of having subclinical symptoms (30%) or clinical disorders (1%), others with symptoms progress to clinical disorders (2%), and a considerable proportion with clinical disorders still had them 5 years later (9%).

“I think for me what this means is early detection of eating disorder symptoms before meeting full-threshold eating disorder criteria is important for early intervention,” Dr. Ackard said, noting that she favors insurance coverage of treatment for youth who do not yet meet full criteria.

In addition, she said, early treatment intervention might keep some young people from progressing to symptoms of greater severity.

“I am a vast proponent of broad, intensive prevention and treatment interventions particularly among youth, and even among youth who are younger than this particular sample we surveyed in this study, because I think everybody in the room is very aware that we see early signs of eating disorders even among 5-, 6-, 7-, and 8-year-olds,” Dr. Ackard said.

She reported that she had no conflicts of interest in association with the study.

Five years after first assessment, considerable flux in the eating disorder groups was evident. DR. ACKARD

VANCOUVER, B.C. — Hospitalist-driven initiatives in quality improvement are at the core of several programs underway at the Society of Hospital Medicine, according to Dr. Larry Wellikson, the society's CEO.

Speaking at the annual Canadian Hospitalist Conference, Dr. Wellikson urged hospitalists to take advantage of these tools and the opportunities that quality improvement offers them to change the status quo in health care.

“Look at performance improvement as part of your DNA, as part of your job, as the gift and the differentiator that you bring to the marketplace, he advised. “It isn't that [others don't] care about quality or performance—it's just that you have the opportunity to seize this, own this, and be the agents of change.”

Quality improvement isn't something you do at the end of the day or “a bunch of people running around with clipboards satisfying some regulations that will grow from 10 to 20 to 100,” he said. Leading the drive for quality improvement is an opportunity to shake up the status quo.

Hospital care is “virtually the only industry where you pay exactly the same thing whether you get the worst care or the best care,” he observed. Moreover, limited measurement of quality outcomes makes it difficult to compare the caliber of care across hospitals.

Hospitalists are in the best position to drive these initiatives. Unlike staff physicians, hospitalists “are owners, not renters,” he said. Hospitalists know their institutions inside and out. They often have more clout to effect change. Further, hospitalists are intrinsically involved in overarching issues, such as drug safety and patient education.

The many guidelines for standards of care that have been written are merely an initial step in quality improvement, he said. The key is how to implement them.

To address implementation needs, the SHM has brought together multidisciplinary groups of experts to create virtual resource rooms on its Web site (www.hospitalmedicine.org

In addition, because tools are best used by skilled physicians, the society offers at its annual and chapter meetings training in how to conduct quality improvement projects, a skill not typically taught as part of medical education, Dr. Wellikson noted.

SHM also has defined core competencies for hospital care and secured funding to pursue implementation projects, in which trained hospitalist leaders mentor other hospitalists conducting projects to improve quality outcomes.

One such project at a University of California, San Diego, hospital nearly doubled the rate of adequate prophylaxis for venous thromboembolism and reduced the annual number of venous thromboembolic events from 50 to 4.

SHM also is leading efforts to set standards for transitions of care at hospital admission and discharge.

The society's long-term strategy for quality improvement emphasizes teamwork and efforts to bring together allied health professionals, Dr. Wellikson explained at the conference, which was sponsored by the University of British Columbia.

“We need to move toward a world where health care is a team sport,” Dr. Wellikson said. Empowering nurses, pharmacists, and other professionals can have benefits all around.

'Look at performance improvement as… the gift or the differentiator that you bring to the marketplace.' DR. WELLIKSON

VANCOUVER, B.C. — Hospitalist-driven initiatives in quality improvement are at the core of several programs underway at the Society of Hospital Medicine, according to Dr. Larry Wellikson, the society's CEO.

Speaking at the annual Canadian Hospitalist Conference, Dr. Wellikson urged hospitalists to take advantage of these tools and the opportunities that quality improvement offers them to change the status quo in health care.

“Look at performance improvement as part of your DNA, as part of your job, as the gift and the differentiator that you bring to the marketplace, he advised. “It isn't that [others don't] care about quality or performance—it's just that you have the opportunity to seize this, own this, and be the agents of change.”

Quality improvement isn't something you do at the end of the day or “a bunch of people running around with clipboards satisfying some regulations that will grow from 10 to 20 to 100,” he said. Leading the drive for quality improvement is an opportunity to shake up the status quo.

Hospital care is “virtually the only industry where you pay exactly the same thing whether you get the worst care or the best care,” he observed. Moreover, limited measurement of quality outcomes makes it difficult to compare the caliber of care across hospitals.

Hospitalists are in the best position to drive these initiatives. Unlike staff physicians, hospitalists “are owners, not renters,” he said. Hospitalists know their institutions inside and out. They often have more clout to effect change. Further, hospitalists are intrinsically involved in overarching issues, such as drug safety and patient education.

The many guidelines for standards of care that have been written are merely an initial step in quality improvement, he said. The key is how to implement them.

To address implementation needs, the SHM has brought together multidisciplinary groups of experts to create virtual resource rooms on its Web site (www.hospitalmedicine.org

In addition, because tools are best used by skilled physicians, the society offers at its annual and chapter meetings training in how to conduct quality improvement projects, a skill not typically taught as part of medical education, Dr. Wellikson noted.

SHM also has defined core competencies for hospital care and secured funding to pursue implementation projects, in which trained hospitalist leaders mentor other hospitalists conducting projects to improve quality outcomes.

One such project at a University of California, San Diego, hospital nearly doubled the rate of adequate prophylaxis for venous thromboembolism and reduced the annual number of venous thromboembolic events from 50 to 4.

SHM also is leading efforts to set standards for transitions of care at hospital admission and discharge.

The society's long-term strategy for quality improvement emphasizes teamwork and efforts to bring together allied health professionals, Dr. Wellikson explained at the conference, which was sponsored by the University of British Columbia.

“We need to move toward a world where health care is a team sport,” Dr. Wellikson said. Empowering nurses, pharmacists, and other professionals can have benefits all around.

'Look at performance improvement as… the gift or the differentiator that you bring to the marketplace.' DR. WELLIKSON

VANCOUVER, B.C. — Hospitalist-driven initiatives in quality improvement are at the core of several programs underway at the Society of Hospital Medicine, according to Dr. Larry Wellikson, the society's CEO.

Speaking at the annual Canadian Hospitalist Conference, Dr. Wellikson urged hospitalists to take advantage of these tools and the opportunities that quality improvement offers them to change the status quo in health care.

“Look at performance improvement as part of your DNA, as part of your job, as the gift and the differentiator that you bring to the marketplace, he advised. “It isn't that [others don't] care about quality or performance—it's just that you have the opportunity to seize this, own this, and be the agents of change.”

Quality improvement isn't something you do at the end of the day or “a bunch of people running around with clipboards satisfying some regulations that will grow from 10 to 20 to 100,” he said. Leading the drive for quality improvement is an opportunity to shake up the status quo.

Hospital care is “virtually the only industry where you pay exactly the same thing whether you get the worst care or the best care,” he observed. Moreover, limited measurement of quality outcomes makes it difficult to compare the caliber of care across hospitals.

Hospitalists are in the best position to drive these initiatives. Unlike staff physicians, hospitalists “are owners, not renters,” he said. Hospitalists know their institutions inside and out. They often have more clout to effect change. Further, hospitalists are intrinsically involved in overarching issues, such as drug safety and patient education.

The many guidelines for standards of care that have been written are merely an initial step in quality improvement, he said. The key is how to implement them.

To address implementation needs, the SHM has brought together multidisciplinary groups of experts to create virtual resource rooms on its Web site (www.hospitalmedicine.org

In addition, because tools are best used by skilled physicians, the society offers at its annual and chapter meetings training in how to conduct quality improvement projects, a skill not typically taught as part of medical education, Dr. Wellikson noted.

SHM also has defined core competencies for hospital care and secured funding to pursue implementation projects, in which trained hospitalist leaders mentor other hospitalists conducting projects to improve quality outcomes.

One such project at a University of California, San Diego, hospital nearly doubled the rate of adequate prophylaxis for venous thromboembolism and reduced the annual number of venous thromboembolic events from 50 to 4.

SHM also is leading efforts to set standards for transitions of care at hospital admission and discharge.

The society's long-term strategy for quality improvement emphasizes teamwork and efforts to bring together allied health professionals, Dr. Wellikson explained at the conference, which was sponsored by the University of British Columbia.

“We need to move toward a world where health care is a team sport,” Dr. Wellikson said. Empowering nurses, pharmacists, and other professionals can have benefits all around.

'Look at performance improvement as… the gift or the differentiator that you bring to the marketplace.' DR. WELLIKSON