Breaking the Grip of Eating Disorders

What fascinates Stephen Wonderlich, Ph.D., professor and associate chair of clinical neuroscience, about the study of eating disorders is that “intellectually, it’s really a fairly unique interaction of a person’s psychology, their biology and their culture which leads people to develop eating disorders,” he said.

Eating disorders include a range of problems most commonly expressed as anorexia nervosa (self-starvation), bulimia (binge eating and purging), and other self-destructive patterns of behavior related to eating.

Nationally, the prevalence of eating disorders (ED) is 2-4 percent, he said.  Although there’s very little data on prevalence of ED statewide, some studies focused on eastern North Dakota show that up to 15 percent of children in grades 7-12 have engaged in eating disorder behavior – extreme dieting, binge eating, vomiting and the misuse of laxatives, diet pills and diuretics.

“A portion of these kids probably try it and quit, but, in some, it solidifies into a medically threatening problem,” said Wonderlich, co-director of the Eating Disorders Institute, co-sponsored by MeritCare Health System, the UND School of Medicine and Health Sciences, and the Neuropsychiatric Research Institute (NRI) in Fargo. 

Co-director is James Mitchell, M.D., Chester Fritz Distinguished Professor of Clinical Neuroscience and the NRI/Lee Christoferson, M.D., Chair of Clinical Neuroscience at the UND medical school.

Their research has revealed, generally, that “over time, people with eating disorders experience unusually high rates of psychiatric problems – depression, anxiety disorders, chemical dependencies,” Wonderlich said.  Also, “early childhood trauma, most often child abuse and neglect, seems to predict the development of complicated and serious forms of the disorder.

“We’re working on some new treatments for these conditions, particularly bulimia nervosa, which may be promising,” he said.

The Eating Disorders Institute is the largest hospital and clinic program devoted to eating disorders between Minneapolis and the West Coast, Wonderlich said.  “The eating disorders professional community marvels at what we have been able to develop here.”

The presence of the Institute in Fargo means that “kids who have serious psychiatric problems can be treated here, and their families can be part of the treatment,” he said.  “Family involvement is crucial to (the patient’s) recovery.  One of the most promising treatments for anorexa nervosa involves families.

“Families are just critical,” he emphasized. “They can have an extremely positive impact, if they

get involved.”

Eating Ourselves to Death    

“We have massive obesity problems in this country,” said James Mitchell, M.D., Chester Fritz Professor and the NRI/Lee Christoferson, M.D., Chair of Clinical Neuroscience, Fargo.  “This is a public health concern that is growing every day.”    

Obesity, to which Mitchell has devoted more of his research efforts in recent years, “is shown to have markedly increased in the last 20 to 30 years, particularly extreme obesity,” he said.  “It is — if not the first — one of the top two or three public health concerns in this country.  It is increasing dramatically and there doesn’t appear to be a foreseeable way to stem this trend.”

In the treatment of obesity, of which there is a high incidence in North Dakota, “current approaches don’t work particularly well,” said Mitchell, adding that health care professionals’ attitudes are negative towards overweight and obese patients. 

“Patients are seen as lazy or uninterested in their own health.  Some professionals provide less than respectful care,” he said.  “They need to see this as a major public health concern; they need to be more empathetic, patient and helpful” with these patients.

One treatment for obesity, bariatric surgery is rising dramatically from a time, in the past, when about 10,000 surgeries were performed annually, to this year during which about 170,000 will be done.

As part of a nationwide study, Mitchell and his colleagues at MeritCare are “looking at how bariatric surgery changes the medical complications of obesity; often these patients have diabetes as well as hypertension and dyslipidemias,” he said.  “We want to determine how effective this type of surgery is and what predictors of problems are.  By analyzing high-risk patients, we hope to learn who will have problems later, after surgery.”

Mitchell’s work also extends to comparing banding with bariatric surgery, “looking at outcomes comparatively,” he said.  Banding is a procedure which involves placing a band around the stomach, creating a pouch in the upper stomach.  It can be done much more easily laparoscopically, but does not render as much weight loss as gastric bypass surgery. 

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