Choosing an eating disorder program
Families and patients who want to win the battle against anorexia, bulimia and other eating disorders face an awful truth - eating disorder treatments often fail. For moderate to severe cases, bulimia/anorexia relapse rates can be as high as 81%. What's more, the consequences of failure can be dire. Precious time is lost, and patients often wind up frustrated and worse off than before.
When evaluating eating disorder treatment options, keep in mind these 7 key criteria questions:
1. Is the eating disorder treatment based on the assumption that anorexia and bulimia are the result of an underlying mental illness?
Because eating disorder patients often display mental health symptoms such as anxiety, depression, obsessive-compulsive disorder or phobias, therapists have long thought that eating disorders are a symptom of an underlying mental illness.
However, there is no evidence available to support the assertion that eating disorders are a consequence of a mental illness. In fact, much of what we know would argue against it.
If eating disorders were really a symptom of underlying mental illness, we would expect:
- mental health symptoms to arrive before the eating problems (they don't).
- the therapies that work on mental health problems should work on eating disorder patients (they don't).
- limiting food intake not to be sufficient to induce the mental health symptoms (it is).
- normalising food intake enough not be sufficient to eliminate the mental health symptoms (but it is).
Based in part on their experiences with hundreds of eating disorder patients, along with data from a post World War II study where volunteers were starved in a manner similar to Holocaust victims, the Mandometer Clinic's founders arrived at the opposite conclusion - namely, that patients don't suffer from eating disorders because they have a mental illness. Rather, patients sometimes exhibit mental illness symptoms because they suffer from an eating disorder.
One successful patient put it another way:
"While everyone else told me I was crazy, the people at the Mandometer Clinic were the only ones who believed me when I told them I wasn't. It turns out I just acted the way I did because I was starving."
The conclusion that the Mandometer Clinic's founders arrived at makes intuitive sense. Thousands of positive chemical reactions occur within the body after a meal is eaten. When the body is denied proper food, it shuts down most activities, and biochemistry becomes dangerously altered, leading to many negative consequences.
The good news is that when anorexics and bulimics begin eating appropriately, their mental symptoms disappear on their own.
2. Does the eating disorder treatment program focus on finding the 'root cause' of the supposed mental illness?
When they are armed with the faulty premise that eating disorder patients are mentally ill, therapists often spend days, weeks, or months digging into their patients' past -- searching for a cause for the disease and/or someone to 'blame'. The overriding theory is that once the patient confronts her past, she can begin the healing process.
The results of this approach can be extremely negative and counterproductive because:
- finding blame does not empower patients to take responsibility to solve their problem.
- constant rehashing of what's wrong with the patient's life leads the patient to focus on her problems, rather than the solutions to her disorder.
- the search for 'secrets' from the patient's past can ultimately tear families apart - often without cause.
At the Mandometer Clinic, we believe that eating disorders are not the fault of parents and are not due to a character flaw in their children.
Our remarkable success rate strongly supports our approach, and illustrates that it is far more effective to focus the patient on the positive - the specific goals she will need to accomplish in order to get better.
3. Do the methods used by the eating disorder treatment program meet an agreed upon 'standard of care' and are they truly proven to work?
Anorexia and bulimia area often described as 'complex and difficult to treat'. As a result, many anorexia treatment centers and bulimia treatment centers use multi-modal treatment plans that incorporate a variety of methods, including cognitive behaviour therapy and drug therapy.
Unfortunately, these methods have little or no scientific evidence validating their use for eating disorders. In other words, there is no 'standard of care' based on proven positive outcomes.
The Mandometer Treatment has been rigorously evaluated using the gold standard of medical research - the Randomized Clinical Trial - and evidence of the effectiveness of the program has been published in a respected, peer-reviewed medical journal.
4. Does the eating disorder treatment program accurately track its success rates?
In reality, very few eating disorder treatment programs track their outcomes consistently and objectively.
Be sure that the eating disorder treatment program you choose tracks the success of every patient and that they have published their data in respected biomedical journals.
The Mandometer Clinic tracks the outcome of every single patient at every single clinic. Our methodology is both rigorous and peer reviewed.
Rather than rate subjective issues such as 'the patient feels happier about herself', we consider eating disorder treatment to be successful only when the patient achieves the following:
- Normal eating behaviour.
- Normal weight.
- Normal blood and urine test results.
- Normal psychiatric status.
- Must be back at school or work and must engage in recreational activities.
- Food and weight are no longer regarded as problems.
- For bulimia, no more binge eating and purging.
Our outcome tracking shows that 75% of our patients achieve ALL of the above criteria, meeting our definition of 'remission'.
Furthermore, we follow patients for a full 5 years after completing the program, and less than 10% of our eating disorder patients relapse.
5. Does the eating disorder treatment program prescribe antidepressant drugs?
The depression caused by anorexia and bulimia can be severe, sometimes leading to suicide. As a result, powerful anti-depressant drugs (Selective Serotonin Reuptake Inhibitors or SSRIs) are commonly prescribed. Leading brands include Prozac, Luvox, Paxil and Zoloft.
These drugs can be appropriate for various mental illnesses. However, the problem is that while most conventional eating disorder treatment facilities prescribe powerful anti-depressant drugs, research has shown that:
- anti-depressants are not effective for the depression associated with anorexia and bulimia; and
- they actually can depress appetite and make it more difficult to recover (see Bergh, et al. 2003).
The Mandometer Clinic does not use anti-depressant drugs as part of eating disorder treatment.
In fact, when a patient who is on anti-depressants enters the Mandometer Clinic, our Medical Director will typically wean her off of these drugs as soon as possible. Warning: if you are currently taking SSRIs, do not discontinue them without the care of a qualified medical doctor.
6. Does the eating disorder treatment program respect each patient as an intelligent, capable and worthy individual?
Unfortunately, many former eating disorder program patients report that they were pressured, did not feel listened to and were not treated as intelligent, capable individuals.
Whether intentional or unintentional, 'strong arm' tactics that attempt to get patients to comply with what is 'best for them' simply do not work. Our extensive experience has shown that eating disorder patients tend to be very smart and very strong willed. And we strongly believe that fighting between therapists and patients is counterproductive.
In short, the more patients are pushed, the more they push back. They quickly learn to become skeptical, suspicious and defensive. Often, the situation can deteriorate to the point where patients become entrenched in their own behaviours in order to 'win'.
No one, not even the Mandometer Clinic, can help a patient who does not want to be helped. You simply cannot force an anorexic or bulimic patient to be cured.
At the Mandometer Clinic, our goal is to help patients become responsible partners in their own care. We motivate patients by showing them how their life will improve once they defeat their eating disorder. Patients set their own short- and long-term goals, and work with the entire staff to achieve them.
In time, patients become more and more excited about how their life will improve once they get well. As progress accelerates, patients embrace all the tools the Mandometer Clinic can give them in order to get well.
Small and large goals can make a huge difference. Patients learn how to drive, take a trip, and engage in many other activities things that are important to them. As a result, the patient's focus is more and more on getting back to life, and less and less on their eating disorder.
7. Does the eating disorder treatment program provide strong assurance that patients won't become 'fat'?
The fear of becoming 'fat' is a critical obstacle that prevents many eating disorder patients from seeking and successfully completing anorexia treatment or bulimia treatment.
Unfortunately, too many conventional eating disorder treatment programs focus on getting patients to gain weight as quickly as possible. This approach is not the best answer because:
- too rapid a weight gain can be medically dangerous;
- patients have more incentive to relapse once they leave a clinic's doors; and
- patients tend to be very suspicious that caregivers will trick them into eating more food than they agreed to, and often resist them at every opportunity.
The Mandometer Clinic succeeds in this area because of the trust our staff members develop with patients, and also because our Mandometer device provides objective data to patients as they eat. This helps them feel in control of their eating in a positive way - often for the first time.
Because patients weigh the food on their plate at the start of every meal, they know exactly how much they are eating. There is no need to worry about being 'tricked' into eating too much.
Out of context this issue may seem unimportant, but to an eating disorder patient, trust regarding food quantity is absolutely critical.