The 2002 Official Patient's Sourcebook on Binge Eating Disorder

THE 2002 OFFICIAL PATIENT’S SOURCEBOOK on INGE ATING ISORDER J AMES N. P ARKER , M.D. AND P HILIP M. P ARKER , P H .D...

Author: James N. Parker | Philip M. Parker

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THE 2002 OFFICIAL PATIENT’S SOURCEBOOK

on

INGE ATING ISORDER J AMES N. P ARKER , M.D. AND P HILIP M. P ARKER , P H .D., E DITORS

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ICON Health Publications ICON Group International, Inc. 4370 La Jolla Village Drive, 4th Floor San Diego, CA 92122 USA Copyright Ó2002 by ICON Group International, Inc. Copyright Ó2002 by ICON Group International, Inc. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without written permission from the publisher. Printed in the United States of America. Last digit indicates print number: 10 9 8 7 6 4 5 3 2 1

Publisher, Health Care: Tiffany LaRochelle Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher’s note: The ideas, procedures, and suggestions contained in this book are not intended as a substitute for consultation with your physician. All matters regarding your health require medical supervision. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation, in close consultation with a qualified physician. The reader is advised to always check product information (package inserts) for changes and new information regarding dose and contraindications before taking any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961Parker, Philip M., 1960The 2002 Official Patient’s Sourcebook on Binge Eating Disorder: A Revised and Updated Directory for the Internet Age/James N. Parker and Philip M. Parker, editors p. cm. Includes bibliographical references, glossary and index. ISBN: 0-597-83180-7 1. Binge Eating Disorder-Popular works. I. Title.

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Disclaimer This publication is not intended to be used for the diagnosis or treatment of a health problem or as a substitute for consultation with licensed medical professionals. It is sold with the understanding that the publisher, editors, and authors are not engaging in the rendering of medical, psychological, financial, legal, or other professional services. References to any entity, product, service, or source of information that may be contained in this publication should not be considered an endorsement, either direct or implied, by the publisher, editors or authors. ICON Group International, Inc., the editors, or the authors are not responsible for the content of any Web pages nor publications referenced in this publication.

Copyright Notice If a physician wishes to copy limited passages from this sourcebook for patient use, this right is automatically granted without written permission from ICON Group International, Inc. (ICON Group). However, all of ICON Group publications are copyrighted. With exception to the above, copying our publications in whole or in part, for whatever reason, is a violation of copyright laws and can lead to penalties and fines. Should you want to copy tables, graphs or other materials, please contact us to request permission (e-mail: [email protected]). ICON Group often grants permission for very limited reproduction of our publications for internal use, press releases, and academic research. Such reproduction requires confirmed permission from ICON Group International Inc. The disclaimer above must accompany all reproductions, in whole or in part, of this sourcebook.

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Dedication To the healthcare professionals dedicating their time and efforts to the study of binge eating disorder.

Acknowledgements The collective knowledge generated from academic and applied research summarized in various references has been critical in the creation of this sourcebook which is best viewed as a comprehensive compilation and collection of information prepared by various official agencies which directly or indirectly are dedicated to binge eating disorder. All of the Official Patient’s Sourcebooks draw from various agencies and institutions associated with the United States Department of Health and Human Services, and in particular, the Office of the Secretary of Health and Human Services (OS), the Administration for Children and Families (ACF), the Administration on Aging (AOA), the Agency for Healthcare Research and Quality (AHRQ), the Agency for Toxic Substances and Disease Registry (ATSDR), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the Healthcare Financing Administration (HCFA), the Health Resources and Services Administration (HRSA), the Indian Health Service (IHS), the institutions of the National Institutes of Health (NIH), the Program Support Center (PSC), and the Substance Abuse and Mental Health Services Administration (SAMHSA). In addition to these sources, information gathered from the National Library of Medicine, the United States Patent Office, the European Union, and their related organizations has been invaluable in the creation of this sourcebook. Some of the work represented was financially supported by the Research and Development Committee at INSEAD. This support is gratefully acknowledged. Finally, special thanks are owed to Tiffany LaRochelle for her excellent editorial support.

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About the Editors James N. Parker, M.D. Dr. James N. Parker received his Bachelor of Science degree in Psychobiology from the University of California, Riverside and his M.D. from the University of California, San Diego. In addition to authoring numerous research publications, he has lectured at various academic institutions. Dr. Parker is the medical editor for the Official Patient’s Sourcebook series published by ICON Health Publications.

Philip M. Parker, Ph.D. Philip M. Parker is the Eli Lilly Chair Professor of Innovation, Business and Society at INSEAD (Fontainebleau, France and Singapore). Dr. Parker has also been Professor at the University of California, San Diego and has taught courses at Harvard University, the Hong Kong University of Science and Technology, the Massachusetts Institute of Technology, Stanford University, and UCLA. Dr. Parker is the associate editor for the Official Patient’s Sourcebook series published by ICON Health Publications.

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About ICON Health Publications In addition to binge eating disorder, Official Patient’s Sourcebooks are available for the following related topics: ·

The Official Patient's Sourcebook on High Blood Pressure

·

The Official Patient's Sourcebook on Obesity

To discover more about ICON Health Publications, simply check with your preferred online booksellers, including Barnes & Noble.com and Amazon.com which currently carry all of our titles. Or, feel free to contact us directly for bulk purchases or institutional discounts: ICON Group International, Inc. 4370 La Jolla Village Drive, Fourth Floor San Diego, CA 92122 USA Fax: 858-546-4341 Web site: www.icongrouponline.com/health

Contents vii

Table of Contents INTRODUCTION...................................................................................... 1

Overview............................................................................................................... 1 Organization......................................................................................................... 3 Scope ..................................................................................................................... 3 Moving Forward................................................................................................... 4

PART I: THE ESSENTIALS ................................................. 7 CHAPTER 1. THE ESSENTIALS ON BINGE EATING DISORDER: GUIDELINES ........................................................................................... 9

Overview............................................................................................................... 9 What Is Binge Eating Disorder? ........................................................................ 11 How Common Is Binge Eating Disorder, and Who Is at Risk? ......................... 12 What Causes Binge Eating Disorder?................................................................ 12 What Are the Complications of Binge Eating Disorder? ................................... 13 Should People with Binge Eating Disorder Try to Diet?................................... 13 How Can People with Binge Eating Disorder Be Helped? ................................ 14 For More Information......................................................................................... 15 Additional Reading............................................................................................. 17 More Guideline Sources ..................................................................................... 18 Vocabulary Builder............................................................................................. 22

CHAPTER 2. SEEKING GUIDANCE ....................................................... 25

Overview............................................................................................................. 25 Associations and Binge Eating Disorder............................................................ 25 Finding More Associations................................................................................. 27 Finding Doctors.................................................................................................. 29 Finding an Endocrinologist................................................................................ 30 Selecting Your Doctor ........................................................................................ 30 Working with Your Doctor ................................................................................ 31 Broader Health-Related Resources ..................................................................... 32

CHAPTER 3. CLINICAL TRIALS AND BINGE EATING DISORDER ......... 33

Overview............................................................................................................. 33 Recent Trials on Binge Eating Disorder ............................................................ 36 Benefits and Risks............................................................................................... 38 Keeping Current on Clinical Trials.................................................................... 41 General References.............................................................................................. 42 Vocabulary Builder............................................................................................. 43

PART II: ADDITIONAL RESOURCES AND ADVANCED MATERIAL.................................................. 45 CHAPTER 4. STUDIES ON BINGE EATING DISORDER .......................... 47

Overview............................................................................................................. 47

viii Contents

The Combined Health Information Database ..................................................... 47 Federally-Funded Research on Binge Eating Disorder ...................................... 54 E-Journals: PubMed Central .............................................................................. 68 The National Library of Medicine: PubMed ...................................................... 68 Vocabulary Builder............................................................................................. 69

CHAPTER 5. BOOKS ON BINGE EATING DISORDER ............................. 73

Overview............................................................................................................. 73 Book Summaries: Federal Agencies .................................................................... 73 Book Summaries: Online Booksellers ................................................................. 77 The National Library of Medicine Book Index ................................................... 82 Chapters on Binge Eating Disorder ................................................................... 86 General Home References ................................................................................... 89 Vocabulary Builder............................................................................................. 89

CHAPTER 6. MULTIMEDIA ON BINGE EATING DISORDER .................. 91

Overview............................................................................................................. 91 Video Recordings ................................................................................................ 91 Bibliography: Multimedia on Binge Eating Disorder ........................................ 93 Vocabulary Builder............................................................................................. 96

CHAPTER 7. PERIODICALS AND NEWS ON BINGE EATING DISORDER 97

Overview............................................................................................................. 97 News Services & Press Releases ......................................................................... 97 Newsletters on Binge Eating Disorder............................................................. 100 Newsletter Articles ........................................................................................... 101 Academic Periodicals covering Binge Eating Disorder.................................... 105 Vocabulary Builder........................................................................................... 107

CHAPTER 8. PHYSICIAN GUIDELINES AND DATABASES ................... 109

Overview........................................................................................................... 109 NIH Guidelines................................................................................................. 109 NIH Databases.................................................................................................. 110 Other Commercial Databases ........................................................................... 115 Specialized References....................................................................................... 115

CHAPTER 9. DISSERTATIONS ON BINGE EATING DISORDER ............ 117

Overview........................................................................................................... 117 Dissertations on Binge Eating Disorder .......................................................... 117 Keeping Current ............................................................................................... 119

PART III. APPENDICES .................................................. 121 APPENDIX A. RESEARCHING YOUR MEDICATIONS.......................... 123

Overview........................................................................................................... 123 Your Medications: The Basics .......................................................................... 124 Learning More about Your Medications .......................................................... 126 Commercial Databases...................................................................................... 127 Contraindications and Interactions (Hidden Dangers) ................................... 128

Contents

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A Final Warning .............................................................................................. 129 General References............................................................................................ 130

APPENDIX B. RESEARCHING ALTERNATIVE MEDICINE ................... 133

Overview........................................................................................................... 133 What Is CAM? ................................................................................................. 133 What Are the Domains of Alternative Medicine?............................................ 134 Can Alternatives Affect My Treatment? ......................................................... 137 Finding CAM References on Binge Eating Disorder....................................... 138 Additional Web Resources................................................................................ 145 General References............................................................................................ 148

APPENDIX C. RESEARCHING NUTRITION ......................................... 151

Overview........................................................................................................... 151 Food and Nutrition: General Principles........................................................... 152 Finding Studies on Binge Eating Disorder ...................................................... 156 Federal Resources on Nutrition........................................................................ 160 Additional Web Resources................................................................................ 161 Vocabulary Builder........................................................................................... 162

APPENDIX D. FINDING MEDICAL LIBRARIES.................................... 165

Overview........................................................................................................... 165 Preparation ....................................................................................................... 165 Finding a Local Medical Library ...................................................................... 166 Medical Libraries Open to the Public............................................................... 166

APPENDIX E. YOUR RIGHTS AND INSURANCE ................................. 173

Overview........................................................................................................... 173 Your Rights as a Patient................................................................................... 173 Patient Responsibilities .................................................................................... 177 Choosing an Insurance Plan............................................................................. 178 Medicare and Medicaid .................................................................................... 180 NORD’s Medication Assistance Programs ..................................................... 183 Additional Resources ........................................................................................ 184

ONLINE GLOSSARIES.................................................... 185 Online Dictionary Directories.......................................................................... 186

BINGE EATING DISORDER GLOSSARY.................. 187 General Dictionaries and Glossaries ................................................................ 195

INDEX................................................................................... 197

Introduction

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INTRODUCTION Overview Dr. C. Everett Koop, former U.S. Surgeon General, once said, “The best prescription is knowledge.”1 The Agency for Healthcare Research and Quality (AHRQ) of the National Institutes of Health (NIH) echoes this view and recommends that every patient incorporate education into the treatment process. According to the AHRQ: Finding out more about your condition is a good place to start. By contacting groups that support your condition, visiting your local library, and searching on the Internet, you can find good information to help guide your treatment decisions. Some information may be hard to find—especially if you don’t know where to look.2 As the AHRQ mentions, finding the right information is not an obvious task. Though many physicians and public officials had thought that the emergence of the Internet would do much to assist patients in obtaining reliable information, in March 2001 the National Institutes of Health issued the following warning: The number of Web sites offering health-related resources grows every day. Many sites provide valuable information, while others may have information that is unreliable or misleading.3

Quotation from http://www.drkoop.com. The Agency for Healthcare Research and Quality (AHRQ): http://www.ahcpr.gov/consumer/diaginfo.htm. 3 From the NIH, National Cancer Institute (NCI): http://cancertrials.nci.nih.gov/beyond/evaluating.html. 1 2

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Binge Eating Disorder

Since the late 1990s, physicians have seen a general increase in patient Internet usage rates. Patients frequently enter their doctor’s offices with printed Web pages of home remedies in the guise of latest medical research. This scenario is so common that doctors often spend more time dispelling misleading information than guiding patients through sound therapies. The Official Patient’s Sourcebook on Binge Eating Disorder has been created for patients who have decided to make education and research an integral part of the treatment process. The pages that follow will tell you where and how to look for information covering virtually all topics related to binge eating disorder, from the essentials to the most advanced areas of research. The title of this book includes the word “official.” This reflects the fact that the sourcebook draws from public, academic, government, and peerreviewed research. Selected readings from various agencies are reproduced to give you some of the latest official information available to date on binge eating disorder. Given patients’ increasing sophistication in using the Internet, abundant references to reliable Internet-based resources are provided throughout this sourcebook. Where possible, guidance is provided on how to obtain free-ofcharge, primary research results as well as more detailed information via the Internet. E-book and electronic versions of this sourcebook are fully interactive with each of the Internet sites mentioned (clicking on a hyperlink automatically opens your browser to the site indicated). Hard copy users of this sourcebook can type cited Web addresses directly into their browsers to obtain access to the corresponding sites. Since we are working with ICON Health Publications, hard copy Sourcebooks are frequently updated and printed on demand to ensure that the information provided is current. In addition to extensive references accessible via the Internet, every chapter presents a “Vocabulary Builder.” Many health guides offer glossaries of technical or uncommon terms in an appendix. In editing this sourcebook, we have decided to place a smaller glossary within each chapter that covers terms used in that chapter. Given the technical nature of some chapters, you may need to revisit many sections. Building one’s vocabulary of medical terms in such a gradual manner has been shown to improve the learning process. We must emphasize that no sourcebook on binge eating disorder should affirm that a specific diagnostic procedure or treatment discussed in a research study, patent, or doctoral dissertation is “correct” or your best option. This sourcebook is no exception. Each patient is unique. Deciding on

Introduction

3

appropriate options is always up to the patient in consultation with their physician and healthcare providers.

Organization This sourcebook is organized into three parts. Part I explores basic techniques to researching binge eating disorder (e.g. finding guidelines on diagnosis, treatments, and prognosis), followed by a number of topics, including information on how to get in touch with organizations, associations, or other patient networks dedicated to binge eating disorder. It also gives you sources of information that can help you find a doctor in your local area specializing in treating binge eating disorder. Collectively, the material presented in Part I is a complete primer on basic research topics for patients with binge eating disorder. Part II moves on to advanced research dedicated to binge eating disorder. Part II is intended for those willing to invest many hours of hard work and study. It is here that we direct you to the latest scientific and applied research on binge eating disorder. When possible, contact names, links via the Internet, and summaries are provided. It is in Part II where the vocabulary process becomes important as authors publishing advanced research frequently use highly specialized language. In general, every attempt is made to recommend “free-to-use” options. Part III provides appendices of useful background reading for all patients with binge eating disorder or related disorders. The appendices are dedicated to more pragmatic issues faced by many patients with binge eating disorder. Accessing materials via medical libraries may be the only option for some readers, so a guide is provided for finding local medical libraries which are open to the public. Part III, therefore, focuses on advice that goes beyond the biological and scientific issues facing patients with binge eating disorder.

Scope While this sourcebook covers binge eating disorder, your doctor, research publications, and specialists may refer to your condition using a variety of terms. Therefore, you should understand that binge eating disorder is often considered a synonym or a condition closely related to the following: ·

Binge-purge Behavior

4

Binge Eating Disorder

·

Bulimia Nervosa

·

Eating Disorder, Bulimic Type

·

Eating Disorders

In addition to synonyms and related conditions, physicians may refer to binge eating disorder using certain coding systems. The International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) is the most commonly used system of classification for the world’s illnesses. Your physician may use this coding system as an administrative or tracking tool. The following classification is commonly used for binge eating disorder:4 ·

307.51 bulimia (overeating of nonorganic origin)

·

783.6 bulimia

For the purposes of this sourcebook, we have attempted to be as inclusive as possible, looking for official information for all of the synonyms relevant to binge eating disorder. You may find it useful to refer to synonyms when accessing databases or interacting with healthcare professionals and medical librarians.

Moving Forward Since the 1980s, the world has seen a proliferation of healthcare guides covering most illnesses. Some are written by patients or their family members. These generally take a layperson’s approach to understanding and coping with an illness or disorder. They can be uplifting, encouraging, and highly supportive. Other guides are authored by physicians or other healthcare providers who have a more clinical outlook. Each of these two styles of guide has its purpose and can be quite useful. As editors, we have chosen a third route. We have chosen to expose you to as many sources of official and peer-reviewed information as practical, for the purpose of educating you about basic and advanced knowledge as recognized by medical science today. You can think of this sourcebook as your personal Internet age reference librarian. This list is based on the official version of the World Health Organization’s 9th Revision, International Classification of Diseases (ICD-9). According to the National Technical Information Service, “ICD-9CM extensions, interpretations, modifications, addenda, or errata other than those approved by the U.S. Public Health Service and the Health Care Financing Administration are not to be considered official and should not be utilized. Continuous maintenance of the ICD-9-CM is the responsibility of the federal government.”

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Introduction

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Why “Internet age”? All too often, patients diagnosed with binge eating disorder will log on to the Internet, type words into a search engine, and receive several Web site listings which are mostly irrelevant or redundant. These patients are left to wonder where the relevant information is, and how to obtain it. Since only the smallest fraction of information dealing with binge eating disorder is even indexed in search engines, a non-systematic approach often leads to frustration and disappointment. With this sourcebook, we hope to direct you to the information you need that you would not likely find using popular Web directories. Beyond Web listings, in many cases we will reproduce brief summaries or abstracts of available reference materials. These abstracts often contain distilled information on topics of discussion. While we focus on the more scientific aspects of binge eating disorder, there is, of course, the emotional side to consider. Later in the sourcebook, we provide a chapter dedicated to helping you find peer groups and associations that can provide additional support beyond research produced by medical science. We hope that the choices we have made give you the most options available in moving forward. In this way, we wish you the best in your efforts to incorporate this educational approach into your treatment plan. The Editors

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PART I: THE ESSENTIALS

ABOUT PART I Part I has been edited to give you access to what we feel are “the essentials” on binge eating disorder. The essentials of a disease typically include the definition or description of the disease, a discussion of who it affects, the signs or symptoms associated with the disease, tests or diagnostic procedures that might be specific to the disease, and treatments for the disease. Your doctor or healthcare provider may have already explained the essentials of binge eating disorder to you or even given you a pamphlet or brochure describing binge eating disorder. Now you are searching for more in-depth information. As editors, we have decided, nevertheless, to include a discussion on where to find essential information that can complement what your doctor has already told you. In this section we recommend a process, not a particular Web site or reference book. The process ensures that, as you search the Web, you gain background information in such a way as to maximize your understanding.

Guidelines

CHAPTER 1. THE ESSENTIALS DISORDER: GUIDELINES

ON

9

BINGE EATING

Overview Official agencies, as well as federally-funded institutions supported by national grants, frequently publish a variety of guidelines on binge eating disorder. These are typically called “Fact Sheets” or “Guidelines.” They can take the form of a brochure, information kit, pamphlet, or flyer. Often they are only a few pages in length. The great advantage of guidelines over other sources is that they are often written with the patient in mind. Since new guidelines on binge eating disorder can appear at any moment and be published by a number of sources, the best approach to finding guidelines is to systematically scan the Internet-based services that post them.

The National Institutes of Health (NIH)5 The National Institutes of Health (NIH) is the first place to search for relatively current patient guidelines and fact sheets on binge eating disorder. Originally founded in 1887, the NIH is one of the world’s foremost medical research centers and the federal focal point for medical research in the United States. At any given time, the NIH supports some 35,000 research grants at universities, medical schools, and other research and training institutions, both nationally and internationally. The rosters of those who have conducted research or who have received NIH support over the years include the world’s most illustrious scientists and physicians. Among them are 97 scientists who have won the Nobel Prize for achievement in medicine.

5

Adapted from the NIH: http://www.nih.gov/about/NIHoverview.html.

10 Binge Eating Disorder

There is no guarantee that any one Institute will have a guideline on a specific disease, though the National Institutes of Health collectively publish over 600 guidelines for both common and rare diseases. The best way to access NIH guidelines is via the Internet. Although the NIH is organized into many different Institutes and Offices, the following is a list of key Web sites where you are most likely to find NIH clinical guidelines and publications dealing with binge eating disorder and associated conditions: ·

Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm

·

National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines available at http://www.nlm.nih.gov/medlineplus/healthtopics.html

·

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); guidelines available at http://www.niddk.nih.gov/health/health.htm

Among these, the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) is particularly noteworthy. The NIDDK’s mission is to conduct and support research on many of the most serious diseases affecting public health.6 The Institute supports much of the clinical research on the diseases of internal medicine and related subspecialty fields as well as many basic science disciplines. The NIDDK’s Division of Intramural Research encompasses the broad spectrum of metabolic diseases such as diabetes, inborn errors of metabolism, endocrine disorders, mineral metabolism, digestive diseases, nutrition, urology and renal disease, and hematology. Basic research studies include biochemistry, nutrition, pathology, histochemistry, chemistry, physical, chemical, and molecular biology, pharmacology, and toxicology. NIDDK extramural research is organized into divisions of program areas: ·

Division of Diabetes, Endocrinology, and Metabolic Diseases

·

Division of Digestive Diseases and Nutrition

·

Division of Kidney, Urologic, and Hematologic Diseases

The Division of Extramural Activities provides administrative support and overall coordination. A fifth division, the Division of Nutrition Research Coordination, coordinates government nutrition research efforts. The Institute supports basic and clinical research through investigator-initiated This paragraph has been adapted from the NIDDK: http://www.niddk.nih.gov/welcome/mission.htm. “Adapted” signifies that a passage is reproduced exactly or slightly edited for this book. 6

Guidelines 11

grants, program project and center grants, and career development and training awards. The Institute also supports research and development projects and large-scale clinical trials through contracts. The following patient guideline was recently published by the NIDDK on binge eating disorder.

What Is Binge Eating Disorder?7 Most of us overeat from time to time, and many people often feel they’ve eaten more than they should have. Eating a lot of food does not always mean that a person has binge eating disorder. Doctors generally agree that most people with serious binge eating problems often ·

Feel their eating is out of control

·

Eat what most people would think is an unusually large amount of food

·

eat much more quickly than usual during binge episodes

·

Eat until so full they are uncomfortable

·

Eat large amounts of food, even when they are not really hungry

·

Eat alone because they are embarrassed about the amount of food they eat

·

Feel disgusted, depressed, or guilty after overeating.

Binge eating also takes place in another eating disorder called bulimia nervosa. Persons with bulimia nervosa, however, usually purge, fast, or do strenuous exercise after they binge eat. Purging means vomiting or using a lot of diuretics (water pills) or laxatives to keep from gaining weight. Fasting is not eating for at least 24 hours. Strenuous exercise, in this case, means exercising for more than an hour just to keep from gaining weight after binge eating. Purging, fasting, and overexercising are dangerous ways to try to control your weight.

Adapted from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK): http://www.niddk.nih.gov/health/nutrit/pubs/binge.htm. 7


How Common Is Binge Eating Disorder, and Who Is at Risk? Binge eating disorder is probably the most common eating disorder. Most people with this problem are either overweight or obese,8 but normal-weight people also can have the disorder. About 2 percent of all adults in the United States (as many as 4 million Americans) have binge eating disorder. About 10 to 15 percent of people who are mildly obese and who try to lose weight on their own or through commercial weight-loss programs have binge eating disorder. The disorder is even more common in people who are severely obese. Binge eating disorder is slightly more common in women than in men; three women for every two men have it. The disorder affects blacks as often as whites. No one knows how often it affects people in other ethnic groups. People who are obese and have binge eating disorder often became overweight at a younger age than those without the disorder. They might also lose and gain back weight (yo-yo diet) more often.

What Causes Binge Eating Disorder? No one knows for sure what causes binge eating disorder. As many as half of all people with binge eating disorder have been depressed in the past. Whether depression causes binge eating disorder or whether binge eating disorder causes depression is not known. Many people who are binge eaters say that being angry, sad, bored, or worried can cause them to binge eat. Impulsive behavior (acting quickly without thinking) and certain other emotional problems can be more common in people with binge eating disorder. It is also unclear if dieting and binge eating are related. Some studies show that about half of all people with binge eating disorder had binge episodes before they started to diet.

The 1998 NIH Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults define overweight as a body mass index (BMI) of 25 to 29.9 and obesity as a BMI of 30 or more. BMI is calculated by dividing weight (in kilograms) by height (in meters) squared.

8

Guidelines 13

Researchers also are looking into how brain chemicals and metabolism (the way the body uses calories) affect binge eating disorder. This research is still in the early stages.

What Are the Complications of Binge Eating Disorder? People with binge eating disorder can get sick because they may not be getting the right nutrients. They usually eat large amounts of fats and sugars, which don’t have a lot of vitamins or minerals. People with binge eating disorder are usually very upset by their binge eating and may become very depressed. People who are obese and also have binge eating disorder are at risk for: ·

Diabetes

·

High blood pressure

·

High blood cholesterol levels

·

Gallbladder disease

·

Heart disease

·

Certain types of cancer.

Most people with binge eating disorder have tried to control it on their own, but have not been able to control it for very long. Some people miss work, school, or social activities to binge eat. Persons who are obese with binge eating disorder often feel bad about themselves and may avoid social gatherings. Most people who binge eat, whether they are obese or not, feel ashamed and try to hide their problem. Often they become so good at hiding it that even close friends and family members don’t know they binge eat.

Should People with Binge Eating Disorder Try to Diet? People who are not overweight should avoid dieting because it sometimes makes their binge eating worse. Dieting here means skipping meals, not eating enough food each day, or avoiding certain kinds of food (such as carbohydrates). These are unhealthy ways to try to change your body shape


and weight. Many people with binge eating disorder are obese and have health problems because of their weight. These people should try to lose weight and keep it off. People with binge eating disorder who are obese may find it harder to stay in a weight-loss program. They also may lose less weight than other people, and may regain weight more quickly. (This can be worse when they also have problems like depression, trouble controlling their behavior, and problems dealing with other people.) These people may need treatment for binge eating disorder before they try to lose weight.

How Can People with Binge Eating Disorder Be Helped? People with binge eating disorder, whether or not they want to lose weight, should get help from a health professional such as a psychiatrist, psychologist, or clinical social worker for their eating behavior. Even those who are not overweight are usually upset by their binge eating, and treatment can help them. There are several different ways to treat binge eating disorder. Cognitive-behavioral therapy teaches people how to keep track of their eating and change their unhealthy eating habits. It also teaches them how to change the way they act in tough situations. Interpersonal psychotherapy helps people look at their relationships with friends and family and make changes in problem areas. Drug therapy, such as antidepressants, may be helpful for some people. Researchers are still trying to find the treatment that is the most helpful in controlling binge eating disorder. The methods mentioned here seem to be equally helpful. For people who are overweight, a weight-loss program that also offers treatment for eating disorders might be the best choice. If you think you might have binge eating disorder, it’s important to know that you are not alone. Most people who have the disorder have tried but failed to control it on their own. You may want to get professional help. Talk to your health care provider about the type of help that may be best. The good news is that most people do well in treatment and can overcome binge eating.

Guidelines 15

For More Information For more information, contact one of the centers listed below. Eating Disorders Awareness and Prevention, Inc. 603 Stewart Street, Suite 803 Seattle, WA 98101 Phone: (206) 382-3587 or 1-800-931-2237 Internet: www.edap.org National Eating Disorders Organization 6655 South Yale Avenue Tulsa, OK 74136 Phone: (918) 481-4044 Academy for Eating Disorders 6728 Old McLean Village Drive McLean, VA 22101-3906 Email: [email protected] Internet: www.acadeatdis.org Conducting clinical studies: Behavioral Medicine Stanford Outpatient Psychiatry 401 Quarry Road Stanford, CA 94305 Phone: (650) 498-9111 Center for Overcoming Problem Eating and Eating Disorders Clinic Western Psychiatric Institute and Clinic 3811 O’Hara Street St. Pittsburgh, PA 15213 Phone: (412) 624-5420 Eating Disorders Clinic New York Psychiatric Institute 1051 Riverside Drive NYSPI Unit 98 New York, NY 10032 Phone: (212) 543-5739


Eating Disorder Research Program University of Minnesota 2701 University Avenue SE., Suite 206 Minneapolis, MN 55414 Phone: (612) 627-4494 Rutgers Eating Disorders Clinic GSAPP, Rutgers University Box 819 Piscataway, NJ 08854 Phone: (732) 445-2292 Center for Eating and Weight Disorders San Diego State University 6495 Alvarado Road, Suite 200 San Diego, CA 92120 Phone: (619) 594-3254 Weight and Eating Disorders Program University of Pennsylvania 3600 Market Street Philadelphia, PA 19104 Phone: (215) 898-7314 Yale Center for Eating Disorders Program Yale University, Department of Psychology P.O. Box 208205 New Haven, CT 06520-8205 Phone: (203) 432-4610 Eating Disorder Program Adolescent and Young Adult Medical Group Children’s Hospital at Strong 610 Elmwood Avenue Box 690 Rochester, NY 14642 Phone: (716) 275-7844

Guidelines 17

Child and Adolescent Eating Disorders Programs Menninger Clinic P.O. Box 829 Topeka, KS 66601-0829 Phone: 1-800-351-9058 Lifespan Weight Management Programs The Miriam Hospital Center for Behavioral and Preventive Medicine 164 Summit Avenue Providence, RI 02906 Phone: 1-800-927-1230

Additional Reading Fairburn CG. Overcoming Binge Eating. New York: Guilford Press, 1995. This book discusses who binges and why, how bingeing differs from overeating, and how a binge eater can gain control. It presents a step-by-step program for overcoming binge eating. Siegel M, Brisman J, Weinshel M. Surviving an Eating Disorder: New Perspectives and Strategies for Family and Friends. New York: HarperCollins, 1997. This book discusses family therapy, psychopharmacology, hospitalization policies, insurance coverage, and support services for binge eating disorder patients and their families. Yanovski SZ. “Binge Eating Disorder: Current Knowledge and Future Directions.” Obesity Research, 1993: Vol. 1, No. 4, pp. 306-323. This review of existing research on binge eating disorder, geared to health professionals, describes treatment methods, discusses their effectiveness, and recommends that doctors treating obese patients be aware of the disorder. Stunkard AJ. “Eating Patterns and Obesity.” Psychiatric Quarterly, 1959: Vol. 33, pp. 284-295. This classic paper provides one of the first descriptions of binge eating in obese individuals. Grilo CM. “The Assessment and Treatment of Binge Eating Disorder.” Journal of Practical Psychiatry and Behavioral Health, 1998: Vol. 4, pp. 191201. This article, written for health professionals, reviews the literature on binge eating disorder with a particular focus on its assessment and treatment. Implications for practice and future research are discussed.


Weight-Control Information Network 1 Win Way Bethesda, MD 20892-3665 Phone: (202) 828-1025 or 1-877-946-4627 Fax: (202) 828-1028 Email: [email protected] The Weight-control Information Network (WIN) is a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health, under the U.S. Public Health Service. Authorized by Congress (Public Law 103-43), WIN assembles and disseminates to health professionals and the public information on weight control, obesity, and nutritional disorders. WIN responds to requests for information; develops, reviews, and distributes publications; and develops communications strategies to encourage individuals to achieve and maintain a healthy weight. Publications produced by WIN are reviewed for scientific accuracy, content, and readability. Materials produced by other sources are also reviewed for scientific accuracy and are distributed, along with WIN publications, to answer requests.

More Guideline Sources The guideline above on binge eating disorder is only one example of the kind of material that you can find online and free of charge. The remainder of this chapter will direct you to other sources which either publish or can help you find additional guidelines on topics related to binge eating disorder. Many of the guidelines listed below address topics that may be of particular relevance to your specific situation or of special interest to only some patients with binge eating disorder. Due to space limitations these sources are listed in a concise manner. Do not hesitate to consult the following sources by either using the Internet hyperlink provided, or, in cases where the contact information is provided, contacting the publisher or author directly.

Topic Pages: MEDLINEplus For patients wishing to go beyond guidelines published by specific Institutes of the NIH, the National Library of Medicine has created a vast and patientoriented healthcare information portal called MEDLINEplus. Within this Internet-based system are “health topic pages.” You can think of a health topic page as a guide to patient guides. To access this system, log on to

Guidelines 19

http://www.nlm.nih.gov/medlineplus/healthtopics.html. From there you can either search using the alphabetical index or browse by broad topic areas. If you do not find topics of interest when browsing health topic pages, then you can choose to use the advanced search utility of MEDLINEplus at http://www.nlm.nih.gov/medlineplus/advancedsearch.html. This utility is similar to the NIH Search Utility, with the exception that it only includes material linked within the MEDLINEplus system (mostly patient-oriented information). It also has the disadvantage of generating unstructured results. We recommend, therefore, that you use this method only if you have a very targeted search.

The Combined Health Information Database (CHID) CHID Online is a reference tool that maintains a database directory of thousands of journal articles and patient education guidelines on binge eating disorder and related conditions. One of the advantages of CHID over other sources is that it offers summaries that describe the guidelines available, including contact information and pricing. CHID’s general Web site is http://chid.nih.gov/. To search this database, go to http://chid.nih.gov/detail/detail.html. In particular, you can use the advanced search options to look up pamphlets, reports, brochures, and information kits. The following was recently posted in this archive: ·

Binge Eating Disorder Source: Bethesda, MD: U.S. Department of Health and Human Services, Public Health Service, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, 4 p., 1993. Contact: Weight-Control Information Network, 1 WIN WAY, BETHESDA, MD 20892-3665. (301) 570-2178 OR (800) 946-8098. Summary: This fact sheet focuses on binge eating disorder (BED) and helps the public and patients determine whether or not they suffer from binge eating problems. The symptoms, causes, complications, and treatment of BED are presented, along with a profile of those at risk for the disorder.

·

About Bulimia Nervosa Source: South Deerfield, MA: Channing L. Bete Co., Inc., 15p., 1994.


Contact: Channing L. Bete Co., Inc., 200 State Road, South Deerfield, MA 01373. (800) 628-7733. Item number 14530. Summary: This consumer education booklet provides essential information about the eating disorder bulimia nervosa. Bulimia nervosa is characterized by binge eating and purging. The booklet emphasizes that if left untreated, this eating disorder is a threat to both physical and emotional health, including colitis, ulcers, liver and kidney damage, and the destruction of tooth enamel. The typical bulimia patient is described, and the signs and symptoms of the disorder are outlined. The reader is reminded that bulimia can be treated and offers suggestions for seeking professional medical and psychological care. ·

Overview of Eating Disorders: Anorexia Nervosa, Bulimia Nervosa, and Related Disorders Source: Worthington, OH: National Eating Disorders Organization, various pagination, 1994. Contact: National Eating Disorders Organization, 445 E. Granville Rd., Worthington, OH 43085. (614) 436-1112. Summary: This packet of information includes fact sheets on the early warning signs of anorexia nervosa, bulimia nervosa, and binge eating disorder. The clinical characteristics of these disorders are also described. The packet also includes guidelines for approaching a person with an eating disorder.

·

Eating Disorders Source: Rockville, MD: U.S. Department of Health and Human Services, Public Health Service, National Institutes of Health, National Institute of Mental Health, 17 p., 1993. Contact: Information Resources and Inquiries Branch, National Institute of Mental Health, 5600 Fishers Lane, Room 7C02, Rockville, MD 20857. (301) 443-4513. NIH Publication Number 93-3477. Summary: Each year millions of people in the United States suffer from serious and sometimes life-threatening eating disorders. The vast majority of those afflicted are adolescent and young adult females. Approximately 1 percent of adolescent girls develop anorexia nervosa, a dangerous condition in which the patient can literally starve themselves to death. Another 2 to 3 percent of young women develop bulimia nervosa, a destructive pattern of excessive eating followed by vomiting or other "purging" behaviors. Approximately 2 percent of the population suffer from binge eating disorder, eating characterized by uncontrolled eating or binging. These eating disorders also occur in men and older

Guidelines 21

women, but less frequently. The consequences of eating disorders can be severe, with 1 in 10 cases leading to death, cardiac arrest, or suicide. This brochure provides valuable information to individuals suffering from eating disorders, as well as to family members and friends trying to help someone cope with the illness. The publication describes the symptoms of eating disorders, possible causes, treatment options, and how to take the first steps toward recovery. The National Guideline Clearinghouse™ The National Guideline Clearinghouse™ offers hundreds of evidence-based clinical practice guidelines published in the United States and other countries. You can search their site located at http://www.guideline.gov by using the keyword “binge eating disorder” or synonyms. The following was recently posted: ·

Practice guideline for the treatment of patients with eating disorders. Source: American Psychiatric Association.; 1993 (updated 2000 Jan); 51 pages http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 1420&sSearch_string=binge+eating+disorder

Healthfinder™ Healthfinder™ is an additional source sponsored by the U.S. Department of Health and Human Services which offers links to hundreds of other sites that contain healthcare information. This Web site is located at http://www.healthfinder.gov. Again, keyword searches can be used to find guidelines. The following was recently found in this database: ·

Eating Disorders: Facts About Eating Disorders and the Search for Solutions Summary: This fact sheet covers anorexia nervosa, bulimia nervosa, binge-eating disorder, and treatment strategies and research findings for these eating disorders. Source: National Institute of Mental Health, National Institutes of Health http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=6624


The NIH Search Utility After browsing the references listed at the beginning of this chapter, you may want to explore the NIH Search Utility. This allows you to search for documents on over 100 selected Web sites that comprise the NIH-WEBSPACE. Each of these servers is “crawled” and indexed on an ongoing basis. Your search will produce a list of various documents, all of which will relate in some way to binge eating disorder. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information for professionals and patients. Nevertheless, a large number of the listed Web sites provide useful background information. We can only recommend this route, therefore, for relatively rare or specific disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html.

Additional Web Sources A number of Web sites that often link to government sites are available to the public. These can also point you in the direction of essential information. The following is a representative sample: ·

AOL: http://search.aol.com/cat.adp?id=168&layer=&from=subcats

·

drkoop.comÒ: http://www.drkoop.com/conditions/ency/index.html

·

Family Village: http://www.familyvillage.wisc.edu/specific.htm

·

Google: http://directory.google.com/Top/Health/Conditions_and_Diseases/

·

Med Help International: http://www.medhelp.org/HealthTopics/A.html

·

Open Directory Project: http://dmoz.org/Health/Conditions_and_Diseases/

·

Yahoo.com: http://dir.yahoo.com/Health/Diseases_and_Conditions/

·

WebMDÒHealth: http://my.webmd.com/health_topics

Vocabulary Builder The material in this chapter may have contained a number of unfamiliar words. The following Vocabulary Builder introduces you to terms used in this chapter that have not been covered in the previous chapter:

Guidelines 23

Anorexia: Lack or loss of the appetite for food. [EU] Antidepressant: An agent that stimulates the mood of a depressed patient, including tricyclic antidepressants and monoamine oxidase inhibitors. [EU] Carbohydrate: An aldehyde or ketone derivative of a polyhydric alcohol, particularly of the pentahydric and hexahydric alcohols. They are so named because the hydrogen and oxygen are usually in the proportion to form water, (CH2O)n. The most important carbohydrates are the starches, sugars, celluloses, and gums. They are classified into mono-, di-, tri-, poly- and heterosaccharides. [EU] Cardiac: Pertaining to the heart. [EU] Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH] Colitis: Inflammation of the colon. [EU] Endocrinology: A subspecialty of internal medicine concerned with the metabolism, physiology, and disorders of the endocrine system. [NIH] Hematology: A subspecialty of internal medicine concerned with morphology, physiology, and pathology of the blood and blood-forming tissues. [NIH] Mental: Pertaining to the mind; psychic. 2. (L. mentum chin) pertaining to the chin. [EU] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Psychiatry: The medical science that deals with the origin, diagnosis, prevention, and treatment of mental disorders. [NIH] Psychology: The science dealing with the study of mental processes and behavior in man and animals. [NIH] Psychopharmacology: The study of the effects of drugs on mental and behavioral activity. [NIH] Psychotherapy: A generic term for the treatment of mental illness or emotional disturbances primarily by verbal or nonverbal communication. [NIH]

Spectrum: A charted band of wavelengths of electromagnetic vibrations obtained by refraction and diffraction. By extension, a measurable range of activity, such as the range of bacteria affected by an antibiotic (antibacterial s.) or the complete range of manifestations of a disease. [EU] Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] Ulcer: A local defect, or excavation, of the surface of an organ or tissue;


which is produced by the sloughing of inflammatory necrotic tissue. [EU] Urology: A surgical specialty concerned with the study, diagnosis, and treatment of diseases of the urinary tract in both sexes and the genital tract in the male. It includes the specialty of andrology which addresses both male genital diseases and male infertility. [NIH]

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CHAPTER 2. SEEKING GUIDANCE Overview Some patients are comforted by the knowledge that a number of organizations dedicate their resources to helping people with binge eating disorder. These associations can become invaluable sources of information and advice. Many associations offer aftercare support, financial assistance, and other important services. Furthermore, healthcare research has shown that support groups often help people to better cope with their conditions.9 In addition to support groups, your physician can be a valuable source of guidance and support. Therefore, finding a physician that can work with your unique situation is a very important aspect of your care. In this chapter, we direct you to resources that can help you find patient organizations and medical specialists. We begin by describing how to find associations and peer groups that can help you better understand and cope with binge eating disorder. The chapter ends with a discussion on how to find a doctor that is right for you.

Associations and Binge Eating Disorder As mentioned by the Agency for Healthcare Research and Quality, sometimes the emotional side of an illness can be as taxing as the physical side.10 You may have fears or feel overwhelmed by your situation. Everyone has different ways of dealing with disease or physical injury. Your attitude, your expectations, and how well you cope with your condition can all Churches, synagogues, and other houses of worship might also have groups that can offer you the social support you need. 10 This section has been adapted from http://www.ahcpr.gov/consumer/diaginf5.htm. 9


influence your well-being. This is true for both minor conditions and serious illnesses. For example, a study on female breast cancer survivors revealed that women who participated in support groups lived longer and experienced better quality of life when compared with women who did not participate. In the support group, women learned coping skills and had the opportunity to share their feelings with other women in the same situation. In addition to associations or groups that your doctor might recommend, we suggest that you consider the following list (if there is a fee for an association, you may want to check with your insurance provider to find out if the cost will be covered): ·

Eating Disorders Awareness and Prevention, Inc Address: Eating Disorders Awareness and Prevention, Inc. 603 Stewart Street, Suite 803, Seattle, WA 98101 Telephone: (206) 382- 3587 Toll-free: (800) 931-2237 Fax: (206) 292-9890 Web Site: http://members.aol.com/edapin Background: Eating Disorders Awareness and Prevention, Inc. (EDAP) is a not- for-profit organization that serves the United States and Canada and is dedicated to increasing awareness of and preventing eating disorders. Eating disorders include self-starvation and excessive weight loss (anorexia nervosa), a secretive cycle of binge eating followed by purging (bulimia nervosa), and compulsive overeating. Established in 1987, EDAP is dedicated to challenging cultural attitudes that may promote the development of eating disorders; advocating the importance of self-esteem based on inner beauty and personal strengths, rather than on appearance or weight; enhancing public and professional awareness of the signs and symptoms of eating disorders and treatment options; emphasizing that early detection and prompt treatment may help to speed the recovery process; and encouraging public understanding of eating disorders to facilitate compassionate, supportive attitudes. Comprised of 750 members, EDAP disseminates information about prevention, early detection, and awareness of eating disorders; maintains a centralized database of information on prevention and health promotion; offers curricula and information to schools and universities across the country; provides information to parents, families, and the organizations that reach them; and provides information to professionals such as nurses, dentists, dietitians, physicians, attorneys, teachers, health educators, coaches, health and fitness instructors, pharmacists, psychotherapists, social workers, and counselors. The organization's materials include brochures, videos, fact sheets, and a regular newsletter

Clinical Trials 27

entitled 'EDAP Matters.' Other programs and activities include the sponsorship of Eating Disorders Awareness Week, the EDAP puppet project for schools, and national conferences. EDAP also maintains a web site at http://members.aol.com/edapinc. Relevant area(s) of interest: Bulimia Nervosa, Eating Disorders

Finding More Associations There are a number of directories that list additional medical associations that you may find useful. While not all of these directories will provide different information than what is listed above, by consulting all of them, you will have nearly exhausted all sources for patient associations. The National Health Information Center (NHIC) The National Health Information Center (NHIC) offers a free referral service to help people find organizations that provide information about binge eating disorder. For more information, see the NHIC’s Web site at http://www.health.gov/NHIC/ or contact an information specialist by calling 1-800-336-4797.

DIRLINE A comprehensive source of information on associations is the DIRLINE database maintained by the National Library of Medicine. The database comprises some 10,000 records of organizations, research centers, and government institutes and associations which primarily focus on health and biomedicine. DIRLINE is available via the Internet at the following Web site: http://dirline.nlm.nih.gov/. Simply type in “binge eating disorder” (or a synonym) or the name of a topic, and the site will list information contained in the database on all relevant organizations.

The Combined Health Information Database Another comprehensive source of information on healthcare associations is the Combined Health Information Database. Using the “Detailed Search” option, you will need to limit your search to “Organizations” and “binge eating disorder”. Type the following hyperlink into your Web browser: http://chid.nih.gov/detail/detail.html. To find associations, use the drop


boxes at the bottom of the search page where “You may refine your search by.” For publication date, select “All Years.” Then, select your preferred language and the format option “Organization Resource Sheet.” By making these selections and typing in “binge eating disorder” (or synonyms) into the “For these words:” box, you will only receive results on organizations dealing with binge eating disorder. You should check back periodically with this database since it is updated every 3 months. The National Organization for Rare Disorders, Inc. The National Organization for Rare Disorders, Inc. has prepared a Web site that provides, at no charge, lists of associations organized by specific diseases. You can access this database at the following Web site: http://www.rarediseases.org/cgi-bin/nord/searchpage. Select the option called “Organizational Database (ODB)” and type “binge eating disorder” (or a synonym) in the search box.

Online Support Groups In addition to support groups, commercial Internet service providers offer forums and chat rooms for people with different illnesses and conditions. WebMDÒ, for example, offers such a service at their Web site: http://boards.webmd.com/roundtable. These online self-help communities can help you connect with a network of people whose concerns are similar to yours. Online support groups are places where people can talk informally. If you read about a novel approach, consult with your doctor or other healthcare providers, as the treatments or discoveries you hear about may not be scientifically proven to be safe and effective. The following Internet links may be of particular interest: ·

DMOZ dmoz.org/Health/Mental_Health/Disorders/ Eating/Support_Groups

·

The Eating Disorder www.edauk.com

·

Healthy Place www.healthyplace.com/Communities/Eating_Disorders

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Finding Doctors One of the most important aspects of your treatment will be the relationship between you and your doctor or specialist. All patients with binge eating disorder must go through the process of selecting a physician. While this process will vary from person to person, the Agency for Healthcare Research and Quality makes a number of suggestions, including the following:11 ·

If you are in a managed care plan, check the plan’s list of doctors first.

·

Ask doctors or other health professionals who work with doctors, such as hospital nurses, for referrals.

·

Call a hospital’s doctor referral service, but keep in mind that these services usually refer you to doctors on staff at that particular hospital. The services do not have information on the quality of care that these doctors provide.

·

Some local medical societies offer lists of member doctors. Again, these lists do not have information on the quality of care that these doctors provide.

Additional steps you can take to locate doctors include the following: ·

Check with the associations listed earlier in this chapter.

·

Information on doctors in some states is available on the Internet at http://www.docboard.org. This Web site is run by “Administrators in Medicine,” a group of state medical board directors.

·

The American Board of Medical Specialties can tell you if your doctor is board certified. “Certified” means that the doctor has completed a training program in a specialty and has passed an exam, or “board,” to assess his or her knowledge, skills, and experience to provide quality patient care in that specialty. Primary care doctors may also be certified as specialists. The AMBS Web site is located at http://www.abms.org/newsearch.asp.12 You can also contact the ABMS by phone at 1-866-ASK-ABMS.

·

You can call the American Medical Association (AMA) at 800-665-2882 for information on training, specialties, and board certification for many licensed doctors in the United States. This information also can be found in “Physician Select” at the AMA’s Web site: http://www.amaassn.org/aps/amahg.htm.

This section is adapted from the AHRQ: www.ahrq.gov/consumer/qntascii/qntdr.htm. While board certification is a good measure of a doctor’s knowledge, it is possible to receive quality care from doctors who are not board certified.

11 12


Finding an Endocrinologist The American Association of Clinical Endocrinologists (AACE) sponsors a Physician Finder database located at http://www.aace.com/memsearch.php. Physician Finder allows you to search for endocrinologists who are members of the AACE by specialty, city, state, or country. According to the AACE: “Members of AACE are physicians with special education, training and interest in the practice of clinical endocrinology. These physicians devote a significant part of their career to the evaluation and management of patients with endocrine disease. All members of AACE are physicians (M.D. or D.O.) and a majority is certified by Boards recognized by the American Board of Medical Specialties. Members of AACE are recognized clinicians, educators and scientists, many of whom are affiliated with medical schools and universities. Members of AACE contribute on a regular and continuing basis to the scientific literature on endocrine diseases and conduct medical education programs on this subject.”13 If the previous sources did not meet your needs, you may want to log on to the Web site of the National Organization for Rare Disorders (NORD) at http://www.rarediseases.org/. NORD maintains a database of doctors with expertise in various rare diseases. The Metabolic Information Network (MIN), 800-945-2188, also maintains a database of physicians with expertise in various metabolic diseases.

Selecting Your Doctor14 When you have compiled a list of prospective doctors, call each of their offices. First, ask if the doctor accepts your health insurance plan and if he or she is taking new patients. If the doctor is not covered by your plan, ask yourself if you are prepared to pay the extra costs. The next step is to schedule a visit with your chosen physician. During the first visit you will have the opportunity to evaluate your doctor and to find out if you feel comfortable with him or her. Ask yourself, did the doctor: ·

Give me a chance to ask questions about binge eating disorder?

·

Really listen to my questions?

·

Answer in terms I understood?

Quotation taken from the AACE’s Web site: http://www.aace.com/memsearch.php. section has been adapted from the AHRQ: www.ahrq.gov/consumer/qntascii/qntdr.htm. 13

14 This

Clinical Trials 31

·

Show respect for me?

·

Ask me questions?

·

Make me feel comfortable?

·

Address the health problem(s) I came with?

·

Ask me my preferences about different kinds of treatments for binge eating disorder?

·

Spend enough time with me?

Trust your instincts when deciding if the doctor is right for you. But remember, it might take time for the relationship to develop. It takes more than one visit for you and your doctor to get to know each other.

Working with Your Doctor15 Research has shown that patients who have good relationships with their doctors tend to be more satisfied with their care and have better results. Here are some tips to help you and your doctor become partners: ·

You know important things about your symptoms and your health history. Tell your doctor what you think he or she needs to know.

·

It is important to tell your doctor personal information, even if it makes you feel embarrassed or uncomfortable.

·

Bring a “health history” list with you (and keep it up to date).

·

Always bring any medications you are currently taking with you to the appointment, or you can bring a list of your medications including dosage and frequency information. Talk about any allergies or reactions you have had to your medications.

·

Tell your doctor about any natural or alternative medicines you are taking.

·

Bring other medical information, such as x-ray films, test results, and medical records.

·

Ask questions. If you don’t, your doctor will assume that you understood everything that was said.

·

Write down your questions before your visit. List the most important ones first to make sure that they are addressed.

This section has been adapted from the AHRQ: www.ahrq.gov/consumer/qntascii/qntdr.htm.

15


·

Consider bringing a friend with you to the appointment to help you ask questions. This person can also help you understand and/or remember the answers.

·

Ask your doctor to draw pictures if you think that this would help you understand.

·

Take notes. Some doctors do not mind if you bring a tape recorder to help you remember things, but always ask first.

·

Let your doctor know if you need more time. If there is not time that day, perhaps you can speak to a nurse or physician assistant on staff or schedule a telephone appointment.

·

Take information home. Ask for written instructions. Your doctor may also have brochures and audio and videotapes that can help you.

·

After leaving the doctor’s office, take responsibility for your care. If you have questions, call. If your symptoms get worse or if you have problems with your medication, call. If you had tests and do not hear from your doctor, call for your test results. If your doctor recommended that you have certain tests, schedule an appointment to get them done. If your doctor said you should see an additional specialist, make an appointment.

By following these steps, you will enhance the relationship you will have with your physician.

Broader Health-Related Resources In addition to the references above, the NIH has set up guidance Web sites that can help patients find healthcare professionals. These include:16 ·

Caregivers: http://www.nlm.nih.gov/medlineplus/caregivers.html

·

Choosing a Doctor or Healthcare Service: http://www.nlm.nih.gov/medlineplus/choosingadoctororhealthcareserv ice.html

·

Hospitals and Health Facilities: http://www.nlm.nih.gov/medlineplus/healthfacilities.html

You can access this information at: http://www.nlm.nih.gov/medlineplus/healthsystem.html.

16

Clinical Trials 33

CHAPTER 3. CLINICAL TRIALS AND BINGE EATING DISORDER Overview Very few medical conditions have a single treatment. The basic treatment guidelines that your physician has discussed with you, or those that you have found using the techniques discussed in Chapter 1, may provide you with all that you will require. For some patients, current treatments can be enhanced with new or innovative techniques currently under investigation. In this chapter, we will describe how clinical trials work and show you how to keep informed of trials concerning binge eating disorder.

What Is a Clinical Trial?17 Clinical trials involve the participation of people in medical research. Most medical research begins with studies in test tubes and on animals. Treatments that show promise in these early studies may then be tried with people. The only sure way to find out whether a new treatment is safe, effective, and better than other treatments for binge eating disorder is to try it on patients in a clinical trial.

The discussion in this chapter has been adapted from the NIH and the NEI: www.nei.nih.gov/netrials/ctivr.htm.

17


What Kinds of Clinical Trials Are There? Clinical trials are carried out in three phases: ·

Phase I. Researchers first conduct Phase I trials with small numbers of patients and healthy volunteers. If the new treatment is a medication, researchers also try to determine how much of it can be given safely.

·

Phase II. Researchers conduct Phase II trials in small numbers of patients to find out the effect of a new treatment on binge eating disorder.

·

Phase III. Finally, researchers conduct Phase III trials to find out how new treatments for binge eating disorder compare with standard treatments already being used. Phase III trials also help to determine if new treatments have any side effects. These trials--which may involve hundreds, perhaps thousands, of people--can also compare new treatments with no treatment. How Is a Clinical Trial Conducted?

Various organizations support clinical trials at medical centers, hospitals, universities, and doctors’ offices across the United States. The “principal investigator” is the researcher in charge of the study at each facility participating in the clinical trial. Most clinical trial researchers are medical doctors, academic researchers, and specialists. The “clinic coordinator” knows all about how the study works and makes all the arrangements for your visits. All doctors and researchers who take part in the study on binge eating disorder carefully follow a detailed treatment plan called a protocol. This plan fully explains how the doctors will treat you in the study. The “protocol” ensures that all patients are treated in the same way, no matter where they receive care. Clinical trials are controlled. This means that researchers compare the effects of the new treatment with those of the standard treatment. In some cases, when no standard treatment exists, the new treatment is compared with no treatment. Patients who receive the new treatment are in the treatment group. Patients who receive a standard treatment or no treatment are in the “control” group. In some clinical trials, patients in the treatment group get a new medication while those in the control group get a placebo. A placebo is a harmless substance, a “dummy” pill, that has no effect on binge eating disorder. In other clinical trials, where a new surgery or device (not a medicine) is being tested, patients in the control group may receive a “sham

Clinical Trials 35

treatment.” This treatment, like a placebo, has no effect on binge eating disorder and does not harm patients. Researchers assign patients “randomly” to the treatment or control group. This is like flipping a coin to decide which patients are in each group. If you choose to participate in a clinical trial, you will not know which group you will be appointed to. The chance of any patient getting the new treatment is about 50 percent. You cannot request to receive the new treatment instead of the placebo or sham treatment. Often, you will not know until the study is over whether you have been in the treatment group or the control group. This is called a “masked” study. In some trials, neither doctors nor patients know who is getting which treatment. This is called a “double masked” study. These types of trials help to ensure that the perceptions of the patients or doctors will not affect the study results. Natural History Studies Unlike clinical trials in which patient volunteers may receive new treatments, natural history studies provide important information to researchers on how binge eating disorder develops over time. A natural history study follows patient volunteers to see how factors such as age, sex, race, or family history might make some people more or less at risk for binge eating disorder. A natural history study may also tell researchers if diet, lifestyle, or occupation affects how a disease or disorder develops and progresses. Results from these studies provide information that helps answer questions such as: How fast will a disease or disorder usually progress? How bad will the condition become? Will treatment be needed? What Is Expected of Patients in a Clinical Trial? Not everyone can take part in a clinical trial for a specific disease or disorder. Each study enrolls patients with certain features or eligibility criteria. These criteria may include the type and stage of disease or disorder, as well as, the age and previous treatment history of the patient. You or your doctor can contact the sponsoring organization to find out more about specific clinical trials and their eligibility criteria. If you are interested in joining a clinical trial, your doctor must contact one of the trial’s investigators and provide details about your diagnosis and medical history. If you participate in a clinical trial, you may be required to have a number of medical tests. You may also need to take medications and/or undergo


surgery. Depending upon the treatment and the examination procedure, you may be required to receive inpatient hospital care. Or, you may have to return to the medical facility for follow-up examinations. These exams help find out how well the treatment is working. Follow-up studies can take months or years. However, the success of the clinical trial often depends on learning what happens to patients over a long period of time. Only patients who continue to return for follow-up examinations can provide this important long-term information.

Recent Trials on Binge Eating Disorder The National Institutes of Health and other organizations sponsor trials on various diseases and disorders. Because funding for research goes to the medical areas that show promising research opportunities, it is not possible for the NIH or others to sponsor clinical trials for every disease and disorder at all times. The following lists recent trials dedicated to binge eating disorder.18 If the trial listed by the NIH is still recruiting, you may be eligible. If it is no longer recruiting or has been completed, then you can contact the sponsors to learn more about the study and, if published, the results. Further information on the trial is available at the Web site indicated. Please note that some trials may no longer be recruiting patients or are otherwise closed. Before contacting sponsors of a clinical trial, consult with your physician who can help you determine if you might benefit from participation. ·

Meditation-Based Treatment for Binge Eating Disorder Condition(s): binge eating disorder; Obesity Study Status: This study is currently recruiting patients. Sponsor(s): National Center for Complementary and Alternative Medicine (NCCAM) Purpose - Excerpt: The purpose of this study is to assess the relative effectiveness of a mindfulness meditation-based intervention for binge eating disorder in comparison to a psycho-educational intervention and a waiting-list control group. Phase(s): Phase II; Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/c/w2r/show/NCT00032760

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These are listed at www.ClinicalTrials.gov.

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Treatment of Bulimia Nervosa in a Primary Care Setting Condition(s): Bulimia Nervosa Study Status: This study is currently recruiting patients. Sponsor(s): National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Purpose - Excerpt: Bulimia Nervosa is a frequent problem for young women. It is widely assumed that this disorder cannot be treated effectively in a primary care setting. This assumption has never been tested empirically, and is probably incorrect. In the last 15 years, effective treatment interventions for Bulimia Nervosa have been developed and validated in specialized treatment centers. The broad aim of this proposal is to examine whether these treatments, suitably adapted, can be usefully transferred to general health care settings. Specifically, the proposed study will determine the relative and combined effectiveness of the two leading treatments for Bulimia Nervosa in a primary care setting. The two major interventions are treatment with an antidepressant medication, fluoxetine, and with a form of cognitive behavioral therapy, guided selfhelp, designed for use in primary care. Study Type: Interventional Contact(s): New York; New York State Psychiatric Institute, New York, New York, 10032, United States; Recruiting; Research Assistant 212-5435151 [email protected]. Study chairs or principal investigators: B. T. Walsh, MD, Principal Investigator; Columbia University Web Site: http://clinicaltrials.gov/ct/gui/c/w2r/show/NCT00009178

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Naltrexone Treatment for Alcoholic Women Condition(s): Alcoholism; Eating Disorder Study Status: This study is completed. Sponsor(s): National Institute on Alcohol Abuse and Alcoholism (NIAAA) Purpose - Excerpt: This study will assess naltrexone's effectiveness in treating alcoholism in women and provide information on its potential value in treating eating disorders common among alcoholic women. Alcoholic women with and without both eating disorders and depression will be randomly assigned to placebo or naltrexone treatment. Each group will receive behavioral therapy for 12 weeks, with followup 6 months after treatment. Phase(s): Phase IV


Study Type: Interventional Contact(s): Connecticut; Substance Abuse Treatment Unit, Yale University, New Haven, Connecticut, 06511, United States; Dr. Stephanie O'Malley 203-789-6988 Web Site: http://clinicaltrials.gov/ct/gui/c/w2r/show/NCT00000448

Benefits and Risks19 What Are the Benefits of Participating in a Clinical Trial? If you are interested in a clinical trial, it is important to realize that your participation can bring many benefits to you and society at large: ·

A new treatment could be more effective than the current treatment for binge eating disorder. Although only half of the participants in a clinical trial receive the experimental treatment, if the new treatment is proved to be more effective and safer than the current treatment, then those patients who did not receive the new treatment during the clinical trial may be among the first to benefit from it when the study is over.

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If the treatment is effective, then it may improve health or prevent diseases or disorders.

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Clinical trial patients receive the highest quality of medical care. Experts watch them closely during the study and may continue to follow them after the study is over.

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People who take part in trials contribute to scientific discoveries that may help other people with binge eating disorder. In cases where certain diseases or disorders run in families, your participation may lead to better care or prevention for your family members. The Informed Consent

Once you agree to take part in a clinical trial, you will be asked to sign an “informed consent.” This document explains a clinical trial’s risks and benefits, the researcher’s expectations of you, and your rights as a patient.

This section has been adapted from ClinicalTrials.gov, a service of the National Institutes of Health: http://www.clinicaltrials.gov/ct/gui/c/a1r/info/whatis?JServSessionIdzone_ct=9jmun6f291. 19

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What Are the Risks? Clinical trials may involve risks as well as benefits. Whether or not a new treatment will work cannot be known ahead of time. There is always a chance that a new treatment may not work better than a standard treatment. There is also the possibility that it may be harmful. The treatment you receive may cause side effects that are serious enough to require medical attention.

How Is Patient Safety Protected? Clinical trials can raise fears of the unknown. Understanding the safeguards that protect patients can ease some of these fears. Before a clinical trial begins, researchers must get approval from their hospital’s Institutional Review Board (IRB), an advisory group that makes sure a clinical trial is designed to protect patient safety. During a clinical trial, doctors will closely watch you to see if the treatment is working and if you are experiencing any side effects. All the results are carefully recorded and reviewed. In many cases, experts from the Data and Safety Monitoring Committee carefully monitor each clinical trial and can recommend that a study be stopped at any time. You will only be asked to take part in a clinical trial as a volunteer giving informed consent.

What Are a Patient’s Rights in a Clinical Trial? If you are eligible for a clinical trial, you will be given information to help you decide whether or not you want to participate. As a patient, you have the right to: ·

Information on all known risks and benefits of the treatments in the study.

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Know how the researchers plan to carry out the study, for how long, and where.

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Know what is expected of you.

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Know any costs involved for you or your insurance provider.

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Know before any of your medical or personal information is shared with other researchers involved in the clinical trial.

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Talk openly with doctors and ask any questions.


After you join a clinical trial, you have the right to: ·

Leave the study at any time. Participation is strictly voluntary. However, you should not enroll if you do not plan to complete the study.

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Receive any new information about the new treatment.

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Continue to ask questions and get answers.

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Maintain your privacy. Your name will not appear in any reports based on the study.

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Know whether you participated in the treatment group or the control group (once the study has been completed). What about Costs?

In some clinical trials, the research facility pays for treatment costs and other associated expenses. You or your insurance provider may have to pay for costs that are considered standard care. These things may include inpatient hospital care, laboratory and other tests, and medical procedures. You also may need to pay for travel between your home and the clinic. You should find out about costs before committing to participation in the trial. If you have health insurance, find out exactly what it will cover. If you don’t have health insurance, or if your insurance company will not cover your costs, talk to the clinic staff about other options for covering the cost of your care. What Should You Ask before Deciding to Join a Clinical Trial? Questions you should ask when thinking about joining a clinical trial include the following: ·

What is the purpose of the clinical trial?

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What are the standard treatments for binge eating disorder? Why do researchers think the new treatment may be better? What is likely to happen to me with or without the new treatment?

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What tests and treatments will I need? Will I need surgery? Medication? Hospitalization?

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How long will the treatment last? How often will I have to come back for follow-up exams?

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What are the treatment’s possible benefits to my condition? What are the short- and long-term risks? What are the possible side effects?

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·

Will the treatment be uncomfortable? Will it make me feel sick? If so, for how long?

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How will my health be monitored?

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Where will I need to go for the clinical trial? How will I get there?

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How much will it cost to be in the study? What costs are covered by the study? How much will my health insurance cover?

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Will I be able to see my own doctor? Who will be in charge of my care?

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Will taking part in the study affect my daily life? Do I have time to participate?

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How do I feel about taking part in a clinical trial? Are there family members or friends who may benefit from my contributions to new medical knowledge?

Keeping Current on Clinical Trials Various government agencies maintain databases on trials. The U.S. National Institutes of Health, through the National Library of Medicine, has developed ClinicalTrials.gov to provide patients, family members, and physicians with current information about clinical research across the broadest number of diseases and conditions. The site was launched in February 2000 and currently contains approximately 5,700 clinical studies in over 59,000 locations worldwide, with most studies being conducted in the United States. ClinicalTrials.gov receives about 2 million hits per month and hosts approximately 5,400 visitors daily. To access this database, simply go to their Web site (www.clinicaltrials.gov) and search by “binge eating disorder” (or synonyms). While ClinicalTrials.gov is the most comprehensive listing of NIH-supported clinical trials available, not all trials are in the database. The database is updated regularly, so clinical trials are continually being added. The following is a list of specialty databases affiliated with the National Institutes of Health that offer additional information on trials: ·

For clinical studies at the Warren Grant Magnuson Clinical Center located in Bethesda, Maryland, visit their Web site: http://clinicalstudies.info.nih.gov/


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For clinical studies conducted at the Bayview Campus in Baltimore, Maryland, visit their Web site: http://www.jhbmc.jhu.edu/studies/index.html

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For trials on diseases of the digestive system and kidneys, and diabetes, visit the National Institute of Diabetes and Digestive and Kidney Diseases: http://www.niddk.nih.gov/patient/patient.htm

General References The following references describe clinical trials and experimental medical research. They have been selected to ensure that they are likely to be available from your local or online bookseller or university medical library. These references are usually written for healthcare professionals, so you may consider consulting with a librarian or bookseller who might recommend a particular reference. The following includes some of the most readily available references (sorted alphabetically by title; hyperlinks provide rankings, information and reviews at Amazon.com): ·

A Guide to Patient Recruitment : Today’s Best Practices & Proven Strategies by Diana L. Anderson; Paperback - 350 pages (2001), CenterWatch, Inc.; ISBN: 1930624115; http://www.amazon.com/exec/obidos/ASIN/1930624115/icongroupinterna

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A Step-By-Step Guide to Clinical Trials by Marilyn Mulay, R.N., M.S., OCN; Spiral-bound - 143 pages Spiral edition (2001), Jones & Bartlett Pub; ISBN: 0763715697; http://www.amazon.com/exec/obidos/ASIN/0763715697/icongroupinterna

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The CenterWatch Directory of Drugs in Clinical Trials by CenterWatch; Paperback - 656 pages (2000), CenterWatch, Inc.; ISBN: 0967302935; http://www.amazon.com/exec/obidos/ASIN/0967302935/icongroupinterna

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The Complete Guide to Informed Consent in Clinical Trials by Terry Hartnett (Editor); Paperback - 164 pages (2000), PharmSource Information Services, Inc.; ISBN: 0970153309; http://www.amazon.com/exec/obidos/ASIN/0970153309/icongroupinterna

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Dictionary for Clinical Trials by Simon Day; Paperback - 228 pages (1999), John Wiley & Sons; ISBN: 0471985961; http://www.amazon.com/exec/obidos/ASIN/0471985961/icongroupinterna

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Extending Medicare Reimbursement in Clinical Trials by Institute of Medicine Staff (Editor), et al; Paperback 1st edition (2000), National Academy Press; ISBN: 0309068886; http://www.amazon.com/exec/obidos/ASIN/0309068886/icongroupinterna

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Handbook of Clinical Trials by Marcus Flather (Editor); Paperback (2001), Remedica Pub Ltd; ISBN: 1901346293; http://www.amazon.com/exec/obidos/ASIN/1901346293/icongroupinterna

Vocabulary Builder The following vocabulary builder gives definitions of words used in this chapter that have not been defined in previous chapters: Cerebral: Of or pertaining of the cerebrum or the brain. [EU] Cortex: The outer layer of an organ or other body structure, as distinguished from the internal substance. [EU] Cortical: Pertaining to or of the nature of a cortex or bark. [EU] Dystonia: Disordered tonicity of muscle. [EU] Fluoxetine: The first highly specific serotonin uptake inhibitor. It is used as an antidepressant and often has a more acceptable side-effects profile than traditional antidepressants. [NIH] Hypersensitivity: A state of altered reactivity in which the body reacts with an exaggerated immune response to a foreign substance. Hypersensitivity reactions are classified as immediate or delayed, types I and IV, respectively, in the Gell and Coombs classification (q.v.) of immune responses. [EU] Invasive: 1. having the quality of invasiveness. 2. involving puncture or incision of the skin or insertion of an instrument or foreign material into the body; said of diagnostic techniques. [EU] Naltrexone: Derivative of noroxymorphone that is the N-cyclopropylmethyl congener of naloxone. It is a narcotic antagonist that is effective orally, longer lasting and more potent than naloxone, and has been proposed for the treatment of heroin addiction. The FDA has approved naltrexone for the treatment of alcohol dependence. [NIH] Pulse: The rhythmical expansion and contraction of an artery produced by waves of pressure caused by the ejection of blood from the left ventricle of the heart as it contracts. [NIH] Skull: The skeleton of the head including the bones of the face and the bones enclosing the brain. [NIH] Trichotillomania: Compulsion to pull out one's hair. [NIH]

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PART II: ADDITIONAL RESOURCES AND ADVANCED MATERIAL

ABOUT PART II In Part II, we introduce you to additional resources and advanced research on binge eating disorder. All too often, patients who conduct their own research are overwhelmed by the difficulty in finding and organizing information. The purpose of the following chapters is to provide you an organized and structured format to help you find additional information resources on binge eating disorder. In Part II, as in Part I, our objective is not to interpret the latest advances on binge eating disorder or render an opinion. Rather, our goal is to give you access to original research and to increase your awareness of sources you may not have already considered. In this way, you will come across the advanced materials often referred to in pamphlets, books, or other general works. Once again, some of this material is technical in nature, so consultation with a professional familiar with binge eating disorder is suggested.

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CHAPTER 4. STUDIES ON BINGE EATING DISORDER Overview Every year, academic studies are published on binge eating disorder or related conditions. Broadly speaking, there are two types of studies. The first are peer reviewed. Generally, the content of these studies has been reviewed by scientists or physicians. Peer-reviewed studies are typically published in scientific journals and are usually available at medical libraries. The second type of studies is non-peer reviewed. These works include summary articles that do not use or report scientific results. These often appear in the popular press, newsletters, or similar periodicals. In this chapter, we will show you how to locate peer-reviewed references and studies on binge eating disorder. We will begin by discussing research that has been summarized and is free to view by the public via the Internet. We then show you how to generate a bibliography on binge eating disorder and teach you how to keep current on new studies as they are published or undertaken by the scientific community.

The Combined Health Information Database The Combined Health Information Database summarizes studies across numerous federal agencies. To limit your investigation to research studies and binge eating disorder, you will need to use the advanced search options. First, go to http://chid.nih.gov/index.html. From there, select the “Detailed Search” option (or go directly to that page with the following hyperlink: http://chid.nih.gov/detail/detail.html). The trick in extracting studies is found in the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the


format option “Journal Article.” At the top of the search form, select the number of records you would like to see (we recommend 100) and check the box to display “whole records.” We recommend that you type in “binge eating disorder” (or synonyms) into the “For these words:” box. Consider using the option “anywhere in record” to make your search as broad as possible. If you want to limit the search to only a particular field, such as the title of the journal, then select this option in the “Search in these fields” drop box. The following is a sample of what you can expect from this type of search: ·

Binge eating disorder: A review of the literature after publication of DSM-IV Source: Eating and Weight Disorders. September 1999. p. 103- 114. Contact: Editrice Kurtis s.r.l., Via Luigi Zoja, 30, 20153 Milano, Italy. http://www.kurtis.it. Summary: Binge Eating Disorder (BED) is a syndrome marked by recurrent episodes of binge eating, in the absence of the regular use of inappropriate compensatory behaviors. This article reviews research on BED since the publication of Diagnostic and Statistical Manual of Mental Disorders (DSM- IV; 4). Binge eating is a common symptom associated with obesity, however BED may be conceptualized as a psychiatric syndrome or it may be viewed as a behavioral symptom associated with obesity.

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Binge Eating Disorder Affects Outcome of Comprehensive Very-LowCalorie Diet Treatment Source: Obesity Research. 2(3):205-12; May 1994. Contact: Weight-Control Information Network, 1 WIN WAY, BETHESDA, MD 20892-3665. (301) 570-2178 OR (800) 946-8098. Summary: This article reports the results of a National Institutes of Health study of weight change among women who met the criteria for binge eating disorder. The study compared the weight loss of obese women with and without binge eating discovered during a very lowcalorie diet program and over the first year following completion of the treatment. The authors concluded that many individuals with binge eating disorder respond well to a medically supervised comprehensive very-low calorie diet program, attaining medically significant weight loss. However, this subgroup appeared to be at risk for early major regain of lost weight, and for poor outcome 1 year following weight-loss treatment.

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Binge Eating Disorder: Current Knowledge and Future Directions Source: Obesity Research. 1(4):306-24, July 1993. Contact: Weight-Control Information Network, 1 WIN WAY, BETHESDA, MD 20892-3665. (301) 570-2178 OR (800) 946-8098. Summary: This article presents currently available data on the diagnosis, epidemiology, clinical characteristics, and treatment for binge eating disorder. The author also suggests areas for future clinical research. Current treatment geared toward binge eating behaviors include antidepressant medications, cognitive behavioral psychotherapy, and interpersonal psychotherapy; however, these treatments have little efficacy in promoting weight loss and only modest success in long-term reduction of binge eating. As a significant proportion of obese individuals entering weight-loss treatment and research programs are likely to meet criteria for binge eating disorder, those conducting clinical research should be aware of this distinct subgroup and determine the contribution of binge eating disorder to outcome measures.

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Binge Eating Disorder: Its Significance in Weight Control Source: The Weight Control Digest. 3(5): 281, 284-90; September/October 1993. Contact: The Weight Control Digest, 1555 West Mockingbird Lane, Suite 205, Dallas, TX 75235. Summary: Binge eating disorder has recently been included in the Diagnostic and Statistical Manual (DSM). This article defines binge eating disorder and considers its diagnosis and treatment. The author presents a psychological model of how binge eating disorder develops, and its prevalence in the United States. The treatment of binge eating disorder includes antidepressant therapy, cognitive-behavioral therapy, and interpersonal therapy. According to the author, the initial therapy should be cognitive-behavioral therapy suitably modified for binge eating disorder. Weight loss therapy per se should not begin until abstinence from binge eating has been attained.

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Physiological Effects of Bulimia Nervosa on the Gastrointestinal Tract Source: Canadian Journal of Gastroenterology. 11(5): 451-459. JulyAugust 1997. Contact: Available from Pulsus Group, Inc. 2902 South Sheridan Way, Oakville, Ontario, Canada L6J 7L6. Summary: The article outlines the physiological effects of bulimia nervosa on the gastrointestinal (GI) tract. Bulimia nervosa is an eating


disorder characterized by frequent bouts of binge eating accompanied by compensatory behavior for preventing weight gain (purging, or vomiting). It is estimated that 3 to 5 percent of young women are affected by bulimia nervosa, and its prevalence is increasing. Bulimia nervosa affects both sexes and all races and can lead to serious medical complications. The expression of the disease in the GI tract may have a critical role in the diagnosis of bulimia nervosa. The gastrointestinal tract undergoes tremendous insult from the effects of acute intakes of large amounts of food and the subsequent purging behaviors. Physiological effects of the disease on the GI tract include dental caries and enamel erosion; enlargement of the parotid gland; esophagitis; changes in gastric capacity and gastric emptying; gastric necrosis; and alterations of the intestinal mucosa. Identification of any of these factors may aid in establishing an early diagnosis, which has been shown to increase the likelihood of recovery. 2 tables. 79 references. (AA-M). ·

Signs of Bulimia Should Be Noted Source: CDA Journal. California Dental Association Journal. 25(12): 832. December 1997. Contact: Available from California Dental Association (CDA). 1201 K Street, Sacramento, CA 95814. (916) 443-0505. Summary: This brief article reminds dentists of the symptoms of bulimia. The author contends that the most common oral manifestations of bulimia nervosa are easily observed, so dentists should watch for them and refer when indicated. Bulimia nervosa, a psychological eating disorder, is characterized by frequent binge eating episodes followed by self-induced vomiting, fasting, excessive exercise, or usage of laxatives or diuretics. Enamel erosion or perimylolysis is one of the most common oral manifestations of bulimia and is a result of the repeated regurgitation of gastric contents. Another frequent oral manifestation of bulimia is an enlargement or swelling of the salivary glands. The oral and pharyngeal mucosal membranes of people with bulimia are often traumatized as a result of the rapid ingestion of large quantities of food and the rapid and forceful regurgitation of the stomach's acidic contents. The membranes of the soft palate and pharynx may have abrasions and bleeding. Other mucosal symptoms include gingival recession due to frequent and rigorous tooth brushing, and angular cheilosis resulting from nutritional deficiency and tissue trauma. The article concludes that any woman displaying one or more of these oral manifestations and who is in the high risk age group (17 to 25 years) should be considered for the possibility of bulimia nervosa and be appropriately referred.

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Eating Disorders and Diabetes Source: Diabetes Forecast. 54(11): 43-45. November 2001. Contact: Available from American Diabetes Association. 1701 North Beauregard Street, Alexandria, VA 22311. (800) 232-3472. Website: www.diabetes.org. Summary: This article discusses the interplay between eating disorders and diabetes mellitus. Written for people who have diabetes, the article reviews the problems associated with eating disorders and their devastating impact on people who have diabetes. Eating disorders always pose a serious health threat. They can cause hormonal disturbances, anemia, brittle bones, and even death. Girls and women with diabetes who have an eating disorder also run a much higher risk of developing the serious medical complications of diabetes, such as kidney and eye disease. Eating disorders can also heighten their immediate risk of diabetic ketoacidosis, a potentially life threatening condition. The author briefly describes anorexia nervosa (characterized by the pursuit of extreme thinness) and bulimia nervosa (characterized by episodes of binge eating, the uncontrolled consumption of large amounts of food). For women with diabetes, issues of food, weight, and emotions can be even more complicated than in women who do not have diabetes. Managing diabetes requires constant attention to food, blood glucose (sugar) levels, exercise, and weight. A diabetes-specific form of an eating disorder may develop in which the person reduces or skips her insulin doses in order to lose weight rapidly. The author offers practical strategies for avoiding the type of thinking that can lead to a problem with eating disorders, and tips for finding a social worker or psychologist to help with these issues. 2 figures.

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What You Should Know About Eating Disorders Source: Diabetes Self-Management. 15(1): 65-69. January-February 1998. Contact: Available from R.A. Rapaport Publishing, Inc. 150 West 22nd Street, New York, NY 10011. (800) 234-0923. Summary: This article provides information about eating disorders and their occurrence among people with diabetes. Researchers have estimated that up to one percent of teenage girls have anorexia, and the rate of bulimia is reportedly as high as 19 percent among females. The author addresses bulimia nervosa, anorexia nervosa, and binge eating disorders; the prevalence of eating disorders among women; the connection between diabetes and eating disorders; and treatment. The author notes that psychological, societal, biological, and familial factors each contribute to the development of an eating disorder. Women with


diabetes seem to be at particular risk, perhaps because of the importance that weight and food take on in the life of almost anyone with diabetes. The article points to cognitive-behavioral psychotherapy as a wellresearched treatment that has been successful in helping people who suffer from eating disorders. The author includes a list of four organizations that can provide additional information about eating disorders. (AA-M). ·

Bulimia and Tooth Erosion Source: Acta Odontologica Scandinavica. 56(1): 36-40. February 1998. Contact: Available from Scandinavian University Press North America. 875 Massachusetts Avenue, Suite 84, Cambridge, MA 02139. (800) 4982877 or (617) 497-6515. Fax (617) 354-6875. E-mail: [email protected]. Website: www.scup.no. Summary: Bulimia is an eating disorder characterized by repeated episodes of binge eating and self induced vomiting, episodes of strict dieting or fasting, and use of laxatives or diuretics. Eating disorders are often associated with regurgitation of gastric contents into the mouth and with dental erosion. This article reports on a study in which the dental status was evaluated in patients with bulimia. The study involved 35 people with bulimia, diagnosed in the Outpatient Departments of Psychiatry and Adolescent Psychiatry of the University Central Hospital in Helsinki, and 105 controls matched for age, sex, and educational level. Each participant was examined clinically, and the factors associated with dental erosion and caries were evaluated in an interview. Severe dental erosion and dental caries were significantly more common among people with bulimia than controls. People with bulimia commonly had a low salivary flow rate, but other apparent risk factors of dental erosion did not differ from those of controls. A feeling of dry mouth was more common among people with bulimia than with controls, and people with bulimia had an increased tooth sensitivity to cold and touch. The authors conclude that more should be done to protect teeth from dental erosion among people with bulimia, because loss of tooth tissue remains, even if the eating disorder disappears. 2 figures. 5 tables. 31 references. (AA-M).

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Complications of Eating Disorders Source: Healthy Weight Journal. 115(2):28-29. March/April 2001. Summary: This article summarizes the mental and physical complications commonly associated with anorexia nervosa and bulimia. Many of the symptoms of anorexia nervosa are directly related to the physical effects of starvation while others deal with attitudes and behavior toward eating

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and weight. Mental complications for anorexia nervosa include decreased energy, moodiness, denial of the eating disorder, inability to concentrate, social withdrawal, preoccupations with body, misperception of hunger and other bodily sensations, and sleep disturbance. Physical complications include electrolyte imbalance, gastrointestinal and cardiovascular disturbances, abnormal temperature regulation, decreased bone mineral density, amenorrhea, anemia, and neurological, renal, and musculocutaneous changes. The person with bulimia may be of normal weight and may not experience the effects of starvation. The mental symptoms associated with bulimia include anxiety, depression, and other negative emotions; poor impulse control; feelings of isolation; constant concern with weight and body image; preoccupation with eating and food; purging and a binge/purge cycle; and dishonesty, lying, stealing, and suicidal tendencies or attempts. Physical problems associated with bulimia include electrolyte imbalance, gastrointestinal and cardiovascular disturbances, possible aspiration pneumonia due to aspiration of vomitus, possible abnormal temperature regulation, menstrual irregularities, possible anemia, neurological and musculocutaneous changes, and dental enamel erosion with vomiting. ·

Position of the American Dietetic Association: Nutrition Intervention in the Treatment of Anorexia Nervosa, Bulimia Nervosa, and Eating Disorders not Otherwise Specified (EDNOS) Source: J Am Diet Assoc. 101(7): 810-819. July 2001. Contact: www.eatright.com/adap0701.html. Summary: More than 5 million Americans suffer from eating disorders. Five percent of females and 1 percent of males have anorexia nervosa, bulimia, or a binge eating disorder. It is estimated that 85 percent of eating disorders occur during adolescence. Although eating disorders are categorized as psychiatric diagnoses, nutritional and medical problems and other issues require the expertise of a registered dietitian. Because of the complex biopsychosocial aspects of eating disorders, the optimal assessment and ongoing management of these conditions belongs with an interdisciplinary team consisting of professionals from medical, nursing, mental health, and nutritional disciplines. Medical nutrition therapy, provided by a registered dietitian trained in the area of eating disorders, plays a significant role in the treatment and management of eating disorders. The registered dietitian, however, must understand the complexities of eating disorders such as comorbid illness, medical and psychological complications, and boundary issues. The dietitian also needs to recognize the specific populations at risk for eating disorders


and the special considerations necessary in dealing with these individuals. ·

Binge Eating Disorder Comes Out of the Closet Source: Tufts University Diet and Nutrition Letter. 14(11):4-5, Jan 1997. Contact: Tufts University Diet and Nutrition Letter, 53 Park Place, New York, NY 10007. Summary: This article characterizes Binge Eating Disorder (BED) as uncontrollable food consumption that is not followed by purging behavior (i.e., laxatives, self-induced vomiting). According to this article, BED is not recognized as a disorder separate from anorexia nervosa and bulimia by the American Psychiatric Association, in spite of the differences. One such difference, says Seda Ebrahimi, director of the eating disorders treatment program at McLean Hospital in Belmont, Massachusetts, is the discomfort and distress felt after a binge. Others include the lack of purging; eating more rapidly than normal; eating until uncomfortably full; eating large amounts when not actually hungry; eating alone because of embarrassment about how much is eaten; and feelings of disgust, depression, and guilt after a binge. Dr. Ebrahimi says there is a relationship between depression and BED, but no one is sure which is the cause and which is the effect. Treatment is usually directed to the depression first, then to the eating behavior.

Federally-Funded Research on Binge Eating Disorder The U.S. Government supports a variety of research studies relating to binge eating disorder and associated conditions. These studies are tracked by the Office of Extramural Research at the National Institutes of Health.20 CRISP (Computerized Retrieval of Information on Scientific Projects) is a searchable database of federally-funded biomedical research projects conducted at universities, hospitals, and other institutions. Visit the CRISP Web site at http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket. You can perform targeted searches by various criteria including geography, date, as well as topics related to binge eating disorder and related conditions.

20 Healthcare projects are funded by the National Institutes of Health (NIH), Substance Abuse and Mental Health Services (SAMHSA), Health Resources and Services Administration (HRSA), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDCP), Agency for Healthcare Research and Quality (AHRQ), and Office of Assistant Secretary of Health (OASH).

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For most of the studies, the agencies reporting into CRISP provide summaries or abstracts. As opposed to clinical trial research using patients, many federally-funded studies use animals or simulated models to explore binge eating disorder and related conditions. In some cases, therefore, it may be difficult to understand how some basic or fundamental research could eventually translate into medical practice. The following sample is typical of the type of information found when searching the CRISP database for binge eating disorder: ·

Project Title: Appetite Focused CBWL for Binge Eating Disorders Principal Investigator & Institution: Craighead, Linda W.; Professor; Psychology; University of Colorado at Boulder Boulder, Co 80309 Timing: Fiscal Year 2000; Project Start 1-JUL-1999; Project End 0-JUN2002 Summary: Over 58 million adults are 20% or more overweight. Between 5-8% of overweight individuals in Community samples, and 30% of those in hospital-affiliated weight loss programs, meet Criteria for binge eating disorder (BED). Cognitive and behavior therapies are the most widely used treatments for eating disorders and obesity. Cognitive behavior therapy (CBT) adapted to treat BED has been shown to reduce binge eating significantly; weight does not change but does remain stable during treatment and follow-up. Standard behavioral weight loss (BWL) has been shown to reduce binge eating as effeCtively as CBT while modest weight loss is achieved, but some of the weight lost is not maintained during follow-up. Thus, more effective treatments are still needed for BED, particularly for those who are also obese, because weight loss and maintenance of weight loss remains problematic--even for those who stop binge eating. The PI has expanded the cognitive model developed for bulimia to address binge and overeating specifically, and she has developed an intervention based on that model which is centered around appetite monitoring. This intervention, Appetite Awareness Training (AAT), is designed to train clients to become more aware of moderate hunger and satiety cues and to teach them to shift control over regulation of eating to these cues. This type of control is hypothesized to be particularly helpful in reduce overeating because the cue to stop eating is internal; for the same reason, this type of control may be easier to maintain long term, potentially enhancing maintenance of weight loss. Pilot data indicate AAT has effects similar to those obtained with standard CBT in initial binge eating reduction, and AAT additionally reduces overeating episodes without promoting increased experiences of hunger. Thus, we hypothesize that integrating the appetite focus of AAT with standard CBT and continuing that focus


during subsequent BWL will enhance binge reduction and facilitate weight loss as well as maintenance of weight loss. The proposed project is to develop a treatment manual that fully integrates CBT and BWL with the appetite focus (CBWL-AF). which would be appropriate for obese individuals with BED. After the manual has been developed and initially tested with training cases, we propose a pilot study for 52 obese women with BED; participants will be randomly assigned to either CBWL-AF or standard BWL. Treatment effects will be assessed at posttest as well as at 3, 6 and 12-month follow-ups. Results from this pilot will be used to revise the manual and provide information regarding whether a larger clinical trial is warranted. A larger trial will be needed for adequate statistical power to identify clear treatment differences and to determine if certain participant characteristics are associated with better response to one of the treatments. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·

Project Title: Cognitive Therapy Via CD ROM for Binge Eating Disorder Principal Investigator & Institution: Bulik, Cynthia M.; Associate Professor; Psychiatry; Virginia Commonwealth University 901 W Franklin St Richmond, Va 23284 Timing: Fiscal Year 2001; Project Start 1-APR-2001; Project End 1-MAR2004 Summary: Although eating and weight-related disorders are treatable, most afflicted individuals never receive proper treatment. Despite the existence of excellent prototype cognitive-behavioral programs for the treatment of binge-eating disorder (BED) and other eating disorders, we face a crisis of dissemination. The goal of this project is to join cognitivebehavioral therapy (CBT) with novel information technology to develop an interactive CBT program that will allow individuals to experience the basics of CBT in the privacy of their own homes. This Exploratory/Development Grant for Mental Health Intervention (R21) proposes a four stage project to develop a CD-ROM-based program for the effective delivery of cognitive-behavioral therapy (CBT) to obese individuals with binge-eating disorder (OBED) and other unhealthy eating behaviors. In Phase 1 of the project, we will continue development of a CD-ROM program that we began in 1998. The program will be a rich, vivid, and interactive approach to CBT that provides helpful psychoeducation on unhealthy eating and weight-related practices; clearly introduces the basic concepts and techniques of CBT; provides rich and vivid examples of techniques; provides individualized and interactive exercises for practicing CBT principles; and enables users to

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contact the central web site and staff with questions. This program will be applicable to a broad range of adult women and men of all races and backgrounds. In Phase 2, we will implement a rigorous four-stage betatesting procedure that includes: group testing sessions followed by individual and focus group debriefing for feedback; peer review by experts in the field of CBT for eating disorders; and in-home beta testing prior to final production. Phase III of the project will be a small feasibility and pilot study comparing the efficacy of the CD-ROM-based delivery of CBT to traditional manual-based group therapy for individuals with OBED and a wait list control. Data from this pilot study will be used to support Phase IV, which will develop a proposal for a large-scale clinical trial comparing CD-ROM-based intervention with traditional group therapy. We anticipate that a CD-ROM-based program will be an efficacious and cost-effective intervention. For some, this program may suffice for treating their eating and weight-related problems. For others, it may be a useful adjunct to traditional psychotherapy or an introductory step to treatment which will familiarize them with the principles and techniques of CBT and increase their comfort and motivation to seek additional professional care. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·

Project Title: Energy Intake in Obese Binge Eating Disorder Individuals Principal Investigator & Institution: Raymond, Nancy C.; Psychiatry; University of Minnesota Twin Cities Twin Cities Minneapolis, Mn 55455 Timing: Fiscal Year 2001; Project Start 5-AUG-2001; Project End 1-JUL2004 Summary: (investigator's abstract): Over the last decade there has been increased recognition that a subset of obese patients report binge eating episodes similar to those seen in patients with bulimia nervosa. However, individuals with binge eating disorder (BED) do not engage in compensatory behavior and therefore tend to become obese. These individuals with BED have the increased health risk associated with obesity, are at increased risk of developing psychiatric disorders, and have high rates of treatment failure making this an important disorder to study. While certain aspects of the eating behavior of individuals with BED have been studied, important questions about energy intake patterns, nutrient composition and food selection remain unanswered. Additionally, some of the best methods that are available for the study of human energy intake have not yet been applied to this population. We propose to use a comparison of results from several methods to develop a detailed understanding of total energy intake, meal patterning, and


nutrient and food selection in obese individuals with BED compared to body mass index (BMI, kg/m2) matched individuals with no history of binge eating. The specific aims of this study are to determine: (1) whether individuals with BED have a higher daily energy intake on average than their non-BED counterparts, (2) how the patterns of energy intake, food selection and nutrient composition differ between individuals with and without a BED diagnosis during meals and overeating episodes, determine the nature of binge eating episodes in the BED population. We hypothesize that: (1) there will be a significant elevation in the total energy intake per day in individuals with BED compared to non-BED individuals; (2) patterns of energy intake will be significantly different between the two groups and; (3) nutrient selection and food selections will differ between individuals with BED and individuals who do not have current or past binge eating episodes. We propose to add to the current body of knowledge in this area with the use of the doubly labeled water (DLW) technique to validate the accuracy of self-reported energy intake records. This study will provide the first direct evidence of the relationship between energy expenditure and self-reported energy intake in individuals with BED. We propose the use of random 24-hour dietary recall interviews to collect dietary intake data in individuals with and without a BED diagnosis. This method has not previously been applied to the study of this disorder. We propose to compare energy intake data collected during binge eating episodes and normal meals in a laboratory setting with comparable data collected during the random dietary recall interviews and the DLW study. A thorough understanding of the energy intake patterns in BED and non-BED individuals will lead to a better understanding of the descriptive nature of the disorder. It will also help to guide treatment priorities and aid researchers in prioritizing which biological systems to study gain insight into the underlying pathophysiology of this disorder. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·

Project Title: Meditation-Based Treatment for Binge Eating Disorder Principal Investigator & Institution: Kristeller, Jean L.; Psychology; Indiana State University 217 N 6Th St Terre Haute, in 47809 Timing: Fiscal Year 2001; Project Start 8-SEP-2001; Project End 0-JUN2003 Summary: As many as 30% of individuals seeking treatment for obesity meet DSM-IV criteria for binge eating disorder (BED) (1). BED is marked by recurrent episodes of bingeing, accompanied by feelings of loss of control, and involves chronic disregulation of physiological, emotional and behavioral systems (2). Meditation-based interventions have been

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used successfully to treat disorders with similar addictive and disregulatory characteristics (3), but have not been applied to treating BED. Data from an uncontrolled pilot study (4) suggests that such an intervention can have marked immediate impact on decreasing episodes of binge eating and other associated characteristics in obese women. Therefore, this study incorporates appropriate comparison conditions to further investigate the efficacy of a mindfulness meditation-based intervention as a treatment component for treating BED symptoms. Exploratory aspects include further development of a manual, establishment of effect size (in comparisof'to appropriate comparison groups), inclusion of a more diverse population, and of measures that address: 1) individual differences in treatment response, 2) possible mechanisms, 3) time course of response, and 3) impact on medical/health variables. Women (approximate N=162) from two communities will be randomly assigned to 3 conditions: 1) an 8-week manualized meditationbased group intervention, 2) a psychoeducational comparison condition, or 3) a waiting-list control. Primary outcome variables will be changes in binge eating behaviors, and associated measures of depression, anxiety, self-esteem, and diet; secondary variables include medical variables sensitive to dietary change (i.e., weight; blood pressure; lipid profile; blood glucose levels), and process variables related to meditation practice, such as the Tellegen Absorption Scale, perceived value and use of the meditation practice, and experiences of increased control and awareness. Participants will be evaluated pre- and post-treatment, and at 1, 3, and 6 months followup. This data would then support the further investigation of a meditation-based intervention as part of a more comprehensive treatment program for BED. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·

Project Title: Psychotherapy and Medication for Binge Eating Disorder Principal Investigator & Institution: Devlin, Michael J.; Associate Professor; New York State Psychiatric Institute 1051 Riverside Dr New York, Ny 10032 Timing: Fiscal Year 2000; Project Start 1-APR-1997; Project End 1-MAR2002 Summary: Binge Eating Disorder (BED) is a recently described eating disorder characterized by binge eating not accompanied by compensatory behavior such as purging, but associated with significant stress. A large proportion of patients with BED are overweight. When presenting for weight control treatment, they exhibit, in addition to their eating disorder, higher rates of associated psychopathology compared to other overweight patients, particularly depressive symptoms. This study


will examine the relative and additive efficacy of two contrasting treatments for BED: individual cognitive behavioral therapy (CBT) and medication. The study sample will consist of 120 overweight patients with BED. All patients will receive standard group behavioral treatment, and the study will determine whether individual CBT, medication, or both CBT and medication confer significant additional benefit compared to this standard treatment. The medications used will be phentermine and fluoxetine, a regimen based on literature suggesting the efficacy of a combination of stimulant and serotonergic agents in weight loss treatment, and on the demonstrated antidepressant efficacy of fluoxetine. Outcome variables will include frequency of binge eating, weight, and measures of overall psychological distress, including depressive symptoms. Treatment will take place over a period of five months, and patients will be followed for two years after treatment. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·

Project Title: THE TREATMENT OF BINGE EATING DISORDER Principal Investigator & Institution: Mitchell, James E.; Professor; Neuropsychiatric Research Institute Box 1415, 700 1St Ave S Fargo, Nd 58107 Timing: Fiscal Year 2002; Project Start 5-FEB-2002; Project End 1-JAN2005 Summary: (provided by applicant): Research over the last few decades has shown that a sub-group of overweight individuals have an abnormal eating pattern best characterized by discrete binge eating episodes. The presence of binge eating episodes in obese individuals is associated with increased rates of psychopathology, social dysfunction, early onset obesity, and greater severity of obesity. However, recent research suggests that binge eating can be effectively treated in obese individuals using certain forms of psychotherapy such as cognitive behavioral techniques, and certain antidepressant drugs, strategies that have also been shown to be useful in suppressing binge eating in individuals of normal weight with bulimia nervosa. Certain self-help techniques have also been shown to be quite useful in improving binge eating symptoms and in encouraging healthy eating behavior in individuals with disordered eating. Our research groups have demonstrated the utility of a self-help manual in working with individuals with bulimia nervosa and most recently the utility of a group self-help approach in targeting binge eating behavior in overweight individuals with binge eating. Therefore, as an extension of our prior research, and given the preliminary data that will be reported in the application, we propose to study the utility of treatments targeting binge eating in obese individuals who binge eat

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through a random assignment, parallel study wherein subjects who satisfy inclusion criteria will be assigned to one of 6 conditions: 1) manual-based self-help targeting binge eating without therapist involvement; 2) supervised manual-based self-help; 3) group self-help therapy, without contact with a psychotherapist; 4) group therapy delivered partially through videotapes and partially with therapist leadership; 5) a traditional therapist-led group psychotherapy, and 6) a wait list control to control for the effects of time and the non-specific effects of being involved in the protocol. Of note, the materials presented in the five treatment arms will be essentially identical, but are written for self-help vs. audio-visual vs. therapy presentation based on the treatment assignment. This protocol is not designed to test a weight loss strategy, but instead to focus on strategies for binge-eating. Such strategies could then be administered in combination with, or sequentially with, various weight loss strategies (e.g., behavioral, pharmacologic) in those who are overweight. Treatments for weight loss are currently undergoing significant evolution with the introduction of two new pharmacologic agents in the last 18 months. We believe that to attempt to address both strategies for binge eating and strategies for weight loss in this study would make it overly complex. The result of this study could inform the design of trials to treat both binge-eating and promote weight loss. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·

Project Title: Adolescent Eating Disorders: A Second Look Principal Investigator & Institution: Petkova, Eva; Assistant Professor; New York State Psychiatric Institute 1051 Riverside Dr New York, Ny 10032 Timing: Fiscal Year 2000; Project Start 1-SEP-2000; Project End 1-AUG2002 Summary: Description (adapted from the investigator's abstract): Eating disorders, a public health problem because of their chronicity and impact on health, typically begin during adolescence. The goal of this study is to identify potential risk and protective factors in adolescents, that may be useful in screening for typical and atypical eating disorders in pediatric practice, and that may generate hypotheses about the etiology of these disorders. A secondary analysis of a two-stage epidemiological study of a countywide high school population (n=5596) completed in 1984-1985, is proposed. The first stage consisted of a survey questionnaire, which provided dimensional assessments of eating attitudes, behaviors, other psychopathology, as well as weight history, medical problems, and menstrual history. The second stage consisted of semi-structured diagnostic interviews, conducted by experienced clinicians, which


yielded psychiatric diagnoses for eating disorders, other selected disorders, as well as more detailed information on correlates of eating disorders. The primary data analysis focused on the prevalence of psychiatric symptoms and disorders in adolescents, and data regarding the relation of potential risk factors to eating disorders was explored only in a preliminary way. Given advances in the nosology of eating disorders and in statistical methods, a second look at this data set is important and timely. In a series of analyses which will include adequate sophisticated statistical techniques, we propose to accomplish the following specific aims: (1) to determine, in boys and girls separately, the relation of potential risk and protective factors for Anorexia Nervosa (AN) and Bulimia Nervosa (BN); factors to be examined include developmental, dieting, weight, health, other psychopathology, family, and demographic factors; (2) to determine if DSM IV eating syndromes are distinct from AN and BN, such as Binge Eating Disorder can be identified in this population and, if so, to determine potential risk factors for these syndromes; (3) to develop efficient screening protocols for eating syndromes, which will exploit not only the cardinal features of each syndrome but also potential risk factors identified above. The strengths of this application lie in the application of both recent advances in the nosology of eating disorders and sophisticated statistical techniques applied to an existing data set. This unique epidemiological dataset, although cross-sectional, contains unparalleled information on the correlates of eating pathology. Findings from this study will contribute to the description and detection of eating disorders in adolescents, will identify potential risk and protective factors for eating pathology and will help generate hypotheses about the etiology of adolescent eating disorders. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·

Project Title: Appetite Awareness in the Prevention of Binge Eating Principal Investigator & Institution: Elder-Paquette, Katherine A.; Psychology; University of Colorado at Boulder Boulder, Co 80309 Timing: Fiscal Year 2000; Project Start 1-SEP-2000 Summary: Approximately 3-6 percent of women in the general population meet full criteria for binge eating disorder (BED). Individuals who suffer with BED for extended periods of time not only develop the emotional distress, which accompanies eating disorders, but are also at risk for obesity. Providing intervention to individuals before the typical onset of BED (onset typically occurs between 19 and 26 years old) may be an effective method of avoiding the long-term negative effects of this eating disorder. The objective of the proposed study is to develop a

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prevention program for college students at risk for developing eating disorders, in particular, binge eating problems. The prevention program will be based on Appetite Awareness Training (AAT), a treatment focused on retraining eating in response to appetite cues which was developed specifically for individuals with BED. The primary goal is to evaluate the effectiveness of AAT in preventing the escalation of eating disordered symptoms in individuals with subclinical BED. This will be accomplished by comparing AAT to a standard psychoeducational program for eating disorders at 5 points: post-intervention and 6-, 12-, 24, and 36-month follow ups. If successful, the prevention program could help individuals at risk for binge eating problems avoid the development of full syndrome BED as well as weight gain. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·

Project Title: Eating Disorders in Young Women--Prevalence and Risk Principal Investigator & Institution: Striegel-Moore, Ruth H.; Professor; Psychology; Wesleyan University Middletown, Ct 06459 Timing: Fiscal Year 2000; Project Start 1-MAY-1998; Project End 8-FEB2003 Summary: (Adapted from the Applicant's Abstract): Eating disorders involving recurrent binge eating (binge eating disorders) pose a significant risk to the health and psychological adjustment of young women. Current knowledge of binge eating disorders is limited by a) the virtual exclusion of minority women from study samples; b) the paucity of studies of women with spectrum binge eating disorders; and c) the over reliance in risk factor studies on retrospective assessment of exposure to risk. As Aim I, the proposed study will assess a cohort of 2,379 young adult black and white women to describe the spectrum of binge eating disorders. Using state-of-the-art case finding interview methods, we will determine prevalence of bulimia nervosa (BN), binge eating disorder (BED), and their spectrum variants (defined as meeting all but one of the criteria required for full syndrome diagnosis); we will also identify presence of current Axis I psychiatric disorders. To determine clinical significance of BN, BED, and their spectrum variants in this community-based sample, we will compare women with a binge eating disorder and healthy controls on measures of obesity and psychological adjustment. The association of race and concomitant variables with eating disorder cases and controls will be examined. Aim II of the study is to develop an empirically based, multifactorial model of risk for binge eating disorders that considers three major risk domains: familial context, constitutional vulnerability, and personal vulnerability. For assessment of exposure to risk, data will be utilized that have been


collected prospectively and longitudinally over a period of ten years in this exceptionally well-maintained cohort. We will examine race differences in the relative contribution of risk factors to the development of binge eating disorders; determine specificity of risk; and compare exposure to risk in women with full syndrome versus women with spectrum binge eating disorders. Our study should generate information relevant for primary prevention by identifying high risk groups and risk factors that may be amenable to change. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·

Project Title: Effects of Macronutrient Intake on Binge Eating Principal Investigator & Institution: Latner, Janet D.; Psychology; Rutgers the St Univ of Nj New Brunswick New Jersey New Brunswick New Brunswick, Nj 08903 Timing: Fiscal Year 2001; Project Start 1-JUN-2001 Summary: The broad objectives of this research are to identify physiological and dietary factors significant in the maintenance of binge eating, a major public health concern in both normal weight and obese individuals. This research also aims to improve current methods of treatment for binge eating and to generate additional strategies for treatment. Protein is more satiating than carbohydrate or fat over the short-and long-term. Protein is one of the most potent stimulant of two satiety agents, cholecystokinin (CCK) and glucagon. Bulimia nervosa (BN) patients and obese patients with binge-eating disorder (BED) may have an impaired satiety response involving the insufficient secretion of CCK. This research aims to test the hypothesis that the administration of protein supplements will reduce binge eating and restore impaired satiety signals in BN and BED patients, while binge eating and satiety signals will not be changed by carbohydrate supplements. It is predicted that during a two-week period of supplementary protein intake, patients with BN and BED will report fewer and smaller binge-eating episodes and less hunger and will consume less at an ad libitum test meal than during supplementary carbohydrate intake. It is also predicted that highprotein meals will produce higher blood levels of glucagon and CCK in patients than high-carbohydrate meals. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket

·

Project Title: Neurobiology of Binge Type Eating Principal Investigator & Institution: Corwin, Rebecca L.; Nutrition; Pennsylvania State University-Univ Park 201 Old Main University Park, Pa 16802

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Timing: Fiscal Year 2000; Project Start 0-AUG-1999; Project End 1-JUL2002 Summary: (Adapted From The Applicant's Abstract): Binge eating is thought to involve significant alterations in brain serotonin levels and receptors that may serve to sustain overeat/restrict patterns of behavior. These changes may also contribute to associated comorbitidy such as depression, alcoholism and obesity. The neurochemical causes and consequences of repeated episodes of binge-type behavior, however, have been difficult to examine directly using human subjects. Furthermore, few animal models have been developed for use in this type of research. The purpose of the proposed research is to examine changes in serotonin levels, receptor density, and sensitivity to serotonergic agonist using a novel rat "binge-eating" procedure developed in my laboratory. In this procedure, nonfood deprived rats are allowed to "nibble" or "binge" on an optional source of fat or carbohydrate for four weeks. After the four-week period, discrete brain regions will be assayed before, during, and after a carbohydrate or fat "binge" and behavioral responses to selective serotonergic agonists will be determined. Three experiments will determine the affects of bingetype behavior on (1) levels of serotonin in discrete brain nuclei, (2) 5HT1B receptor density in discrete brain nuclei, (3) sensitivity to 5HT1B and 5HT2C receptor agonists. The independent contributions of consumption pattern and type of food consumed to changes in serotonin and its receptors will be systematically evaluated. These studies will provide important basic information relevant to understanding the neurobiological consequences of binge-type eating behavior. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·

Project Title: Self-Help Computer Services for Eating Disorders Principal Investigator & Institution: Bedrosian, Richard C.; ; Recovery and Support Technologies 184 Otis St Northboro, Ma 01532 Timing: Fiscal Year 2001; Project Start 1-SEP-2001; Project End 0-JUN2002 Summary: (provided by applicant): This application proposes research related to NIMH Division of Services and Intervention Research. The aim is to design and test the first prototype of an interactive self-help computer program for binge eating disorder. The prototype will be based on an integrative view of the etiology of binge eating disorder, and will combine elements of various empirically supported treatment approaches. Each user will receive a customized learning experience, resulting in customized feedback from the program. We will conduct the following evaluations of the module: (1) Expert Reviews of Content and


Usability, (2) Stage One Usability Test (with eating disorder subjects), and (3) Stage Two Usability Test (with eating disorder subjects). Dependent measures and formal criteria for success are specified. PROPOSED COMMERCIAL APPLICATION: Potential commercial markets for eating disorders self-help technology include psychotherapy clients, mental health professionals, and health maintenance organizations. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·

Project Title: Stomach Capacity and Emptying in Obesity Principal Investigator & Institution: Geliebter, Allan; ; St. Luke'sRoosevelt Inst for Hlth Scis Health Sciences New York, Ny 10019 Timing: Fiscal Year 2000; Project Start 1-SEP-1999; Project End 1-AUG2002 Summary: (Adapted From The Applicant's Abstract): Obesity, which can lead to a variety of chronic diseases and reduced life span, continues to increase in prevalence in the US. A subset of obese subjects (30 percent of those entering medical weight-loss programs) has the recently characterized binge-eating disorder (BED), ingestion of very large meals without purging as occurs in bulimia nervosa. We have shown that stomach capacity is greater in obese than lean subjects, but this may be due mainly to the BED subset. We hypothesize that stomach capacity is larger in obese BED subjects than in obese non-BED subjects and lean subjects. Stomach capacity will be estimated by filling a gastric balloon in 24 obese BED and 24 non-obese subjects and 24 lean controls, each group divided equally by sex. Gastric capacity will be estimated from a) maximum volume tolerated and b) volume required to induce a given rise in intragastric pressure. Gastric capacity will be correlated with laboratory test-meal intake. Gastric emptying of a liquid meal will also be determined and related to gastric capacity. From out previous work, we would predict slower emptying, especially in the early phase, from a stomach with a large capacity. During the gastric emptying test, blood will be sampled for plasma cholecystokinin (CCK), a satiety peptide, shown to be lower in bulimics postprandially. The reduced CCK in bulimics may be the result of slower gastric emptying and larger gastric capacity and is predicted to be reduced in BED. The extent to which gastric capacity and emptying, test meal intake, and CCK change after restrictive dieting in obese subjects will then be determined. The obese BED and non-BED subjects will be randomized for 3 mo. of a) cognitivebehavior modification with a recommended intake of 5016 kJ/day (1200 kcal/day) or b) ad-lib intake. Gastric capacity may not decline in BED subjects if it is a primary factor in the disorder. Body composition,

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including underwater weighing wil be assessed before and after this period. Afterwards, a double-blind, dose-response study of a gastric emptying accelerant (cisapride) will be conducted in 12 non-dieting subjects of each group. Especially for the BED group, cisapride may speed emptying, enhance CCK release, and increase satiety. The lowest effective dose will then be used in a double-blind, 2 month crossover clinical trial of 12 obese non-BED subjects. Body weight and composition will be assessed at the start and monthly. The studies may enhance knowledge of the etiology, pathophysiology, and treatment of BED. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·

Project Title: The Prevalence of Two Eating Disorders Principal Investigator & Institution: Stunkard, Albert J.; Professor Emeritus of Psychiatry; Psychiatry; University of Pennsylvania 1 College Hall Philadelphia, Pa 19104 Timing: Fiscal Year 2001; Project Start 0-SEP-2001; Project End 1-AUG2004 Summary: (provided by applicant): Two eating disorders, binge eating disorder (BED) and the night eating syndrome (NES), have been associated with obesity. There is reason to believe that they contribute to the obesity and that controlling them might contribute to the control of obesity. The prevalence of these disorders is not known. We hope that this proposed study will help to determine this prevalence and the extent to which the disorders are associated with the severity of obesity. Binge eating disorder is characterized by a subjective feeling of loss of control over what is being consumed and an objective consumption of an amount of food "definitely larger than most people would eat." Night eating syndrome consists of morning anorexia, evening hyperphagia, lowering of mood late in the day, and nighttime awakenings, during which time food-usually high in carbohydrates is consumed. Our proposed study seeks to delineate how common each of these eating disorders is among the Look AHEAD population and, if possible, the stability of the diagnosis in the course of the first year of treatment. One thousand randomly selected subjects from five Look AHEAD sites, including both men and women and irrespective of race or ethnicity, will be administered screening questionnaires that assess both the BED and NES criteria. From those screening questionnaires, 20 percent of persons with the highest scores for NES and those scoring above a cutoff (20 percent +/-5 percent) for BED will be contacted for follow-up clinical phone interviews to reduce the number of subjects who are falsely selfidentified. This information will be gathered upon subjects' entry into the


Look AHEAD trial and again at six months and one year into treatment to assess the stability of the diagnosis. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket

E-Journals: PubMed Central21 PubMed Central (PMC) is a digital archive of life sciences journal literature developed and managed by the National Center for Biotechnology Information (NCBI) at the U.S. National Library of Medicine (NLM).22 Access to this growing archive of e-journals is free and unrestricted.23 To search, go to http://www.pubmedcentral.nih.gov/index.html#search, and type “binge eating disorder” (or synonyms) into the search box. This search gives you access to full-text articles. The following is a sample of items found for binge eating disorder in the PubMed Central database: ·

The SCOFF questionnaire: assessment of a new screening tool for eating disorders by John F Morgan, Fiona Reid, and J Hubert Lacey; 1999 December 4 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=28290

The National Library of Medicine: PubMed One of the quickest and most comprehensive ways to find academic studies in both English and other languages is to use PubMed, maintained by the National Library of Medicine. The advantage of PubMed over previously mentioned sources is that it covers a greater number of domestic and foreign references. It is also free to the public.24 If the publisher has a Web site that offers full text of its journals, PubMed will provide links to that site, as well Adapted from the National Library of Medicine: http://www.pubmedcentral.nih.gov/about/intro.html. 22 With PubMed Central, NCBI is taking the lead in preservation and maintenance of open access to electronic literature, just as NLM has done for decades with printed biomedical literature. PubMed Central aims to become a world-class library of the digital age. 23 The value of PubMed Central, in addition to its role as an archive, lies the availability of data from diverse sources stored in a common format in a single repository. Many journals already have online publishing operations, and there is a growing tendency to publish material online only, to the exclusion of print. 24 PubMed was developed by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine (NLM) at the National Institutes of Health (NIH). The PubMed database was developed in conjunction with publishers of biomedical literature as a search tool for accessing literature citations and linking to full-text journal articles at Web sites of participating publishers. Publishers that participate in PubMed supply NLM with their citations electronically prior to or at the time of publication. 21

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as to sites offering other related data. User registration, a subscription fee, or some other type of fee may be required to access the full text of articles in some journals. To generate your own bibliography of studies dealing with binge eating disorder, simply go to the PubMed Web site at www.ncbi.nlm.nih.gov/pubmed. Type “binge eating disorder” (or synonyms) into the search box, and click “Go.” The following is the type of output you can expect from PubMed for “binge eating disorder” (hyperlinks lead to article summaries): ·

Binge eating disorder: prevalence and psychopathological features in a clinical sample of obese people in Italy. Author(s): Ramacciotti CE, Coli E, Passaglia C, Lacorte M, Pea E, Dell'Osso L. Source: Psychiatry Research. 2000 May 15; 94(2): 131-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10808038&dopt=Abstract

·

Cognitive-behavioral self-help for binge eating disorder: a controlled effectiveness study. Author(s): Carter JC, Fairburn CG. Source: J Consult Clin Psychol. 1998 August; 66(4): 616-23. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9735577&dopt=Abstract

·

Body dissatisfaction and its interrelations with other risk factors for bulimia nervosa in 12 countries. Author(s): Jaeger B, Ruggiero GM, Edlund B, Gomez-Perretta C, Lang F, Mohammadkhani P, Sahleen-Veasey C, Schomer H, Lamprecht F. Source: Psychotherapy and Psychosomatics. 2002 January-February; 71(1): 54-61. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11740169&dopt=Abstract

Vocabulary Builder Abrasion: 1. the wearing away of a substance or structure (such as the skin or the teeth) through some unusual or abnormal mechanical process. 2. an area of body surface denuded of skin or mucous membrane by some unusual or abnormal mechanical process. [EU] Adolescence: The period of life beginning with the appearance of secondary


sex characteristics and terminating with the cessation of somatic growth. The years usually referred to as adolescence lie between 13 and 18 years of age. [NIH]

Agonist: In anatomy, a prime mover. In pharmacology, a drug that has affinity for and stimulates physiologic activity at cell receptors normally stimulated by naturally occurring substances. [EU] Amenorrhea: amenia. [EU]

Absence or abnormal stoppage of the menses; called also

Anemia: A reduction in the number of circulating erythrocytes or in the quantity of hemoglobin. [NIH] Anxiety: The unpleasant emotional state consisting of psychophysiological responses to anticipation of unreal or imagined danger, ostensibly resulting from unrecognized intrapsychic conflict. Physiological concomitants include increased heart rate, altered respiration rate, sweating, trembling, weakness, and fatigue; psychological concomitants include feelings of impending danger, powerlessness, apprehension, and tension. [EU] Aspiration: The act of inhaling. [EU] Atypical: Irregular; not conformable to the type; in microbiology, applied specifically to strains of unusual type. [EU] Cardiovascular: Pertaining to the heart and blood vessels. [EU] Cerebrospinal: Pertaining to the brain and spinal cord. [EU] Chronic: Persisting over a long period of time. [EU] Concomitant: Accompanying; accessory; joined with another. [EU] Constitutional: 1. affecting the whole constitution of the body; not local. 2. pertaining to the constitution. [EU] Cues: Signals for an action; that specific portion of a perceptual field or pattern of stimuli to which a subject has learned to respond. [NIH] Deprivation: Loss or absence of parts, organs, powers, or things that are needed. [EU] Electrolyte: A substance that dissociates into ions when fused or in solution, and thus becomes capable of conducting electricity; an ionic solute. [EU] Epidemiological: Relating to, or involving epidemiology. [EU] Esophagitis: Inflammation, acute or chronic, of the esophagus caused by bacteria, chemicals, or trauma. [NIH] Gastrointestinal: Pertaining to or communicating with the stomach and intestine, as a gastrointestinal fistula. [EU] Glucose: D-glucose, a monosaccharide (hexose), C6H12O6, also known as dextrose (q.v.), found in certain foodstuffs, especially fruits, and in the

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normal blood of all animals. It is the end product of carbohydrate metabolism and is the chief source of energy for living organisms, its utilization being controlled by insulin. Excess glucose is converted to glycogen and stored in the liver and muscles for use as needed and, beyond that, is converted to fat and stored as adipose tissue. Glucose appears in the urine in diabetes mellitus. [EU] Hormonal: Pertaining to or of the nature of a hormone. [EU] Hunger: The desire for food generated by a sensation arising from the lack of food in the stomach. [NIH] Hyperphagia: Ingestion of a greater than optimal quantity of food. [NIH] Ingestion: The act of taking food, medicines, etc., into the body, by mouth. [EU]

Inpatients: Persons admitted to health facilities which provide board and room, for the purpose of observation, care, diagnosis or treatment. [NIH] Insulin: A protein hormone secreted by beta cells of the pancreas. Insulin plays a major role in the regulation of glucose metabolism, generally promoting the cellular utilization of glucose. It is also an important regulator of protein and lipid metabolism. Insulin is used as a drug to control insulindependent diabetes mellitus. [NIH] Ketoacidosis: Acidosis accompanied by the accumulation of ketone bodies (ketosis) in the body tissues and fluids, as in diabetic acidosis. [EU] LH: A small glycoprotein hormone secreted by the anterior pituitary. LH plays an important role in controlling ovulation and in controlling secretion of hormones by the ovaries and testes. [NIH] Lipid: Any of a heterogeneous group of flats and fatlike substances characterized by being water-insoluble and being extractable by nonpolar (or fat) solvents such as alcohol, ether, chloroform, benzene, etc. All contain as a major constituent aliphatic hydrocarbons. The lipids, which are easily stored in the body, serve as a source of fuel, are an important constituent of cell structure, and serve other biological functions. Lipids may be considered to include fatty acids, neutral fats, waxes, and steroids. Compound lipids comprise the glycolipids, lipoproteins, and phospholipids. [EU] Membrane: A thin layer of tissue which covers a surface, lines a cavity or divides a space or organ. [EU] Metabolite: process. [EU]

Any substance produced by metabolism or by a metabolic

Mucosa: A mucous membrane, or tunica mucosa. [EU] Necrosis: The sum of the morphological changes indicative of cell death and caused by the progressive degradative action of enzymes; it may affect groups of cells or part of a structure or an organ. [EU]


Pediatrics: A medical specialty concerned with maintaining health and providing medical care to children from birth to adolescence. [NIH] Pharmacologic: Pertaining to pharmacology or to the properties and reactions of drugs. [EU] Phentermine: A central nervous system stimulant and sympathomimetic with actions and uses similar to those of dextroamphetamine. It has been used most frequently in the treatment of obesity. [NIH] Pneumonia: Inflammation of the lungs with consolidation. [EU] Psychopathology: The study of significant causes and processes in the development of mental illness. [NIH] Psychosomatic: Pertaining to the mind-body relationship; having bodily symptoms of psychic, emotional, or mental origin; called also psychophysiologic. [EU] Receptor: 1. a molecular structure within a cell or on the surface characterized by (1) selective binding of a specific substance and (2) a specific physiologic effect that accompanies the binding, e.g., cell-surface receptors for peptide hormones, neurotransmitters, antigens, complement fragments, and immunoglobulins and cytoplasmic receptors for steroid hormones. 2. a sensory nerve terminal that responds to stimuli of various kinds. [EU] Regurgitation: A backward flowing, as the casting up of undigested food, or the backward flowing of blood into the heart, or between the chambers of the heart when a valve is incompetent. [EU] Secretion: 1. the process of elaborating a specific product as a result of the activity of a gland; this activity may range from separating a specific substance of the blood to the elaboration of a new chemical substance. 2. any substance produced by secretion. [EU] Stimulant: 1. producing stimulation; especially producing stimulation by causing tension on muscle fibre through the nervous tissue. 2. an agent or remedy that produces stimulation. [EU] Subclinical: Without clinical manifestations; said of the early stage(s) of an infection or other disease or abnormality before symptoms and signs become apparent or detectable by clinical examination or laboratory tests, or of a very mild form of an infection or other disease or abnormality. [EU] Withdrawal: 1. a pathological retreat from interpersonal contact and social involvement, as may occur in schizophrenia, depression, or schizoid avoidant and schizotypal personality disorders. 2. (DSM III-R) a substancespecific organic brain syndrome that follows the cessation of use or reduction in intake of a psychoactive substance that had been regularly used to induce a state of intoxication. [EU]

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CHAPTER 5. BOOKS ON BINGE EATING DISORDER Overview This chapter provides bibliographic book references relating to binge eating disorder. You have many options to locate books on binge eating disorder. The simplest method is to go to your local bookseller and inquire about titles that they have in stock or can special order for you. Some patients, however, feel uncomfortable approaching their local booksellers and prefer online sources (e.g. www.amazon.com and www.bn.com). In addition to online booksellers, excellent sources for book titles on binge eating disorder include the Combined Health Information Database and the National Library of Medicine. Once you have found a title that interests you, visit your local public or medical library to see if it is available for loan.

Book Summaries: Federal Agencies The Combined Health Information Database collects various book abstracts from a variety of healthcare institutions and federal agencies. To access these summaries, go to http://chid.nih.gov/detail/detail.html. You will need to use the “Detailed Search” option. To find book summaries, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer. For the format option, select “Monograph/Book.” Now type “binge eating disorder” (or synonyms) into the “For these words:” box. You will only receive results on books. You should check back periodically with this database which is updated every 3 months. The following is a typical result when searching for books on binge eating disorder:


·

Eating Disorders and Obesity. A Comprehensive Handbook Source: New York, NY: Guilford Publishing, 583p., 1995. Contact: Guilford Publishing, 72 Spring Street, New York, NY 10012. (212) 431-9800. Summary: This book is designed to serve as a resource for eating disorder and obesity specialists. The book is divided into nine sections. Section I covers the regulation of eating and weight naturally, including such factors as genetic influences, cigarette smoking, pregnancy, physiological, psychological, and energy related factors. Section II focuses on the importance of dieting in modern society. Section III highlights the issue of measurement. Sections IV through VII cover all aspects of eating disorders including history, clinical features, theories of pathogenesis, complications, as well as detailed views on approaches to treatments. Sections VIII and IX cover obesity in a similar fashion.

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Nutrition and eating disorders Source: Philadelphia, PA: Hanley and Belfus. 1992. 187 pp. Contact: Available from Hanley and Belfus, 210 South 13th Street, Philadelphia, PA 19107. Telephone: (215) 546-4995. $63.00 for yearly subscription to three issues in the series. Summary: This publication discusses future expectations for improvement in adolescent nutrition, adolescent fitness, cultural aspects of adolescent nutrition, vegetarian adolescents, nutrition for the pregnant adolescent, obese adolescents, hyperlipidemia, anorexia and bulimia nervosa, amenorrhea in anorexia nervosa, and nutrition management in adolescents with eating disorders.

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Eating Disorders and Athletes: A Handbook for Coaches Source: Dubuque, IA, Kendall/Hunt Publishing Company, 90 p., 1991. Contact: Kendall/Hunt Publishing Company, 2460 Kerper Boulevard, P.O. Box 539, Dubuque, IA 52004-0539. Summary: Eating Disorders and Athletes: A Handbook for Coaches provides athletic coaches and those who work closely with athletes with information to help them develop prevention/intervention protocols for athletes exhibiting eating disorders. Chapters discuss (1) the susceptibility of athletes to eating disorders; (2) definitions, symptoms, and risk factors for eating disorders; (3) basic strategies for prevention and intervention; (4) the role of sports nutrition; (5) research findings and case studies of athletes who have had eating disorders; and (6) a literature review of eating disorders among athletes and within specific

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sports. The book contains numerous appendices that provide (1) survey results of eating disorders, (2) a partial list of physical problems brought about by eating disorders, (3) psychosocial influences contributing to disordered eating, (4) how to identify pathogenic weight-control behavior, (5) ways of approaching an athlete with an eating disorder, (6) a list of eating disorder organizations, (7) a reading list on eating disorders, (8) a list of sports nutrition resources, (9) a healthy eating guide, and (10) a list of the recommended minimum number of food servings per day. ·

The Eating Disorder Sourcebook: A Comprehensive Guide to the Causes, Treatments, and Prevention of Eating Disorders Source: Los Angeles: Lowell House, 284 p., 1997. Contact: Lowell House, 2020 Avenue of the Stars, Suite 300, Los Angeles CA 90067. Summary: Costin covers all aspects of eating disorders in this book. Chapter topics include genetic factors, psychosocial factors, activity disorder, prevalence of eating disorder among males, the role of the family, diagnosis, therapy options, medical management of eating disorders, inpatient treatment, and prevention.

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Food Fight: A Guide to Eating Disorders for Preteens and Their Parents Source: New York: Simon and Schuster, 154 p., 1997. Contact: Simon and Schuster Children's Publishing Division, 1230 Avenue of the Americas, New York, NY 10020. Summary: Bode has written a book aimed at preteens and their parents. Through sharing the stories of eating disordered preteens, she discusses what eating disorders are and why individuals may develop them. The first part of the book is written at the preteen level, the second half at the adult level. A final section offers resources and further reading for both preteens and their parents.

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Looking at Body Image and Eating Disorders Source: Santa Cruz, CA: ETR Associates. 1991. Contact: Sales Department, ETR Associates, P.O. Box 1830, Santa Cruz, CA 95061-1830. 1-800-321-4407. Summary: Aimed at the early adolescent, this workbook focuses on body image; how self-images are formed by television, movies, and advertisements; how the individual feels about his or her own body; and the false body images held by those with eating disorders. Information on


each of the disorders is given, along with suggestions for helping a friend who may suffer from one of these disorders. Charts give basic pointers on nutrition and healthy eating for weight loss, as well as guidelines for choosing a diet program. ·

Health Risks of Obesity. 2nd. ed Source: Hettinger, ND: Healthy Living Institute, 1993. Contact: Healthy Living Institute, 402 S. 14th St., Hettinger, ND 58639. (701) 567-2645. Summary: Compiled from the author's articles in Obesity and Health, this book discusses the risks of obesity. Obese individuals are predisposed to certain illnesses, such as diabetes, cancer, heart disease, and stroke. Ms. Berg analyzes the reasons for this, and the statistics she has gathered substantiate this conclusion. Included are articles from Obesity and Health on such issues as weight cycling, eating disorders, and so on. Ms. Berg goes on to discuss the health risks of losing weight as well, and the difficulty of balancing the risks of losing weight vs. the risks of overweight. Several appendixes give the definition of obesity, measuring obesity, and conference and consensus statements from the NIH.

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Body Image, Eating Disorders, and Obesity: An Integrative Guide for Assessment and Treatment Source: Carlsbad, CA : Guerze Books, 515p., 1996. Contact: Guerze Books, P.O. Box 2238 Carlsbad, CA 92018. (800) 756-7533. www.guerze.com. Summary: The book helps practitioners to distinguish individuals with healthy appearance-related concerns from those who suffer disturbances of body image. The 19 chapters cover physical and psychological diagnoses, treatment planning, and protocols for interventions. Also included is an extensive review of the literature.

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Treating Eating Disorders Source: Carlsbad, CA : Guerze Books, 416p., 1996. Contact: Guerze Books, P.O. Box 2238 Carlsbad, CA 92018. (800) 756-7533. www.guerze.com. Summary: Werne and Yalom describe the therapeutic approaches of 14 therapists to eating disorders. Approaches include individual, group, family, couple, in- and outpatient, and day treatment. Frameworks described range from psychodynamic to systemic to cognitive behavioral.

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·

Hope, Help, and Healing for Eating Disorders. A New Approach to Treating Anorexia, Bulimia, and Overeating Source: Wheaton, IL: Harold Shaw Publishers, 200p., 1995. Contact: The Center for Counseling and Health Resources, Inc., PO Box 700, 611 Main, Edmonds, WA 98020. (206) 771-5166. Summary: This is a self-help book for those who suffer from an eating disorder. The author presents a "whole person" approach to eating disorders that encompasses the physical, emotional, relational, and spiritual aspect sof the patient and the disorder. Each chapter discusses one issue regarding the various facets of eating disorders. The author considers the role of the family, patient denial, health complications, nutrition, guilt and anger, and selecting the appropriate helping professional.

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Helping Athletes With Eating Disorders Source: Champaign, IL: Human Kinetics, 194p., 1993. Contact: Human Kinetics, P.O. Box 5076, Champaign, IL 61825- 5076. http://www.humankinetics.com/. (800) 747-4457. Summary: Thompson and Sherman address the issue of athletes with eating disorders. They take a broad view of the term `athletes,' and include participants in such sports as gymnastics, ice skating, dancers, wrestling, and horse racing (jockeys). The authors examine eating disorders as a clinical condition, taking into consideration issues of treatment as well as sport. Two chapters focus on managing the athlete with an eating disorder from these two aspects. Also discussed are the effects of bulimia and anorexia on sports performance, and education and prevention.

Book Summaries: Online Booksellers Commercial Internet-based booksellers, such as Amazon.com and Barnes & Noble.com, offer summaries which have been supplied by each title’s publisher. Some summaries also include customer reviews. Your local bookseller may have access to in-house and commercial databases that index all published books (e.g. Books in PrintÒ). The following have been recently listed with online booksellers as relating to binge eating disorder (sorted alphabetically by title; follow the hyperlink to view more details at Amazon.com):


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Anorexia and Bulimia : Puzzling Eating Disorders #452 by Laura Deni (1985); ISBN: 9996761290; http://www.amazon.com/exec/obidos/ASIN/9996761290/icongroupin terna

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Anorexia and Bulimia Puzzling Eating Disorders (452) by Laura Deni (1984); ISBN: 9995385627; http://www.amazon.com/exec/obidos/ASIN/9995385627/icongroupin terna

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Anorexia Nervosa : A Clinician's Guide to Treatment by Walter Vandereycken, Rolf Meermann (1984); ISBN: 3110095319; http://www.amazon.com/exec/obidos/ASIN/3110095319/icongroupin terna

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Anorexia Nervosa : A Multidimensional Perspective by Paul E. Garfinkel, David M. Garner (1982); ISBN: 0876302975; http://www.amazon.com/exec/obidos/ASIN/0876302975/icongroupin terna

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Anorexia Nervosa : Finding the Life Line by Barbara Unell, Patricia Stein (1985); ISBN: 089638084X; http://www.amazon.com/exec/obidos/ASIN/089638084X/icongroupi nterna

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Anorexia Nervosa and Bulimia : An Annotated Bibliography (Compubibs : 13) by Izabella Taler (1985); ISBN: 0914791125; http://www.amazon.com/exec/obidos/ASIN/0914791125/icongroupin terna

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Anorexia Nervosa and Bulimia: Diagnosis and Treatment (Univ of Minnesota Continuing Medical Education, Vol 3) by James E., M.D. Mitchell (Editor) (1985); ISBN: 0816613885; http://www.amazon.com/exec/obidos/ASIN/0816613885/icongroupin terna

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Anorexia Nervosa and Bulimic Disorders: Current Perspectives by G.I. Szmukler (Editor) (1986); ISBN: 0080327044; http://www.amazon.com/exec/obidos/ASIN/0080327044/icongroupin terna

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Anorexia Nervosa, Recent Developments in Research by International Conf on Anorexia Nervosa (1983); ISBN: 047183498X; http://www.amazon.com/exec/obidos/ASIN/047183498X/icongroupi nterna

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Are You Hungry?: A Completely New Approach to Raising Children Free of Food and Weight Problems by Jane R. Hirschmann, Lela Zaphiropoulos (1985); ISBN: 0394541464;

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http://www.amazon.com/exec/obidos/ASIN/0394541464/icongroupin terna ·

Battling Anorexia by Anita Haney (1986); ISBN: 0892651113; http://www.amazon.com/exec/obidos/ASIN/0892651113/icongroupin terna

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Battling Anorexia: A Deadly Trap by Anita Haney (1986); ISBN: B00005U7U3; http://www.amazon.com/exec/obidos/ASIN/B00005U7U3/icongroupi nterna

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Bulimia : Book for Therapist and Client by Barbara G. Bauer, et al (1986); ISBN: 0915202565; http://www.amazon.com/exec/obidos/ASIN/0915202565/icongroupin terna

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Bulimia: A Systems Approach to Treatment by Maria P.P. Root, et al (1986); ISBN: 0393700240; http://www.amazon.com/exec/obidos/ASIN/0393700240/icongroupin terna

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Counseling Those with Eating Disorders by Raymond E. Vath (1986); ISBN: 0849905834; http://www.amazon.com/exec/obidos/ASIN/0849905834/icongroupin terna

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Current Treatment of Anorexia Nervosa and Bulimia (Karger Biobehavioral Medicine Series, Vol. 4) by Pauline S. Powers, Robert C. Fernandez (Editor) (1984); ISBN: 3805538790; http://www.amazon.com/exec/obidos/ASIN/3805538790/icongroupin terna

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Eating Disorders (1973); ISBN: 0686523385; http://www.amazon.com/exec/obidos/ASIN/0686523385/icongroupin terna

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Eating Disorders by Touyz (1985); ISBN: 0803699298; http://www.amazon.com/exec/obidos/ASIN/0803699298/icongroupin terna

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Eating Disorders (1985); ISBN: 0864330189; http://www.amazon.com/exec/obidos/ASIN/0864330189/icongroupin terna

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Eating Disorders : Obesity, Anorexia Nervosa, and the Person Within by Hilda Bruch, Hilde Bruch (1985); ISBN: 0465017827; http://www.amazon.com/exec/obidos/ASIN/0465017827/icongroupin terna


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Eating Disorders : Prevalence and Treatment by S.W. Touyz, P.J.V. Beumont (1985); ISBN: 0683100416; http://www.amazon.com/exec/obidos/ASIN/0683100416/icongroupin terna

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Eating Disorders: Obesity, Anorexia Nervosa, and Bulimia in Childhood and Adolescence by D.W. Kaplan (Editor) (1986); ISBN: 3805542690; http://www.amazon.com/exec/obidos/ASIN/3805542690/icongroupin terna

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Handbook of Eating Disorders : Physiology, Psychology, and Treatment of Obesity, Anorexia, and Bulimia by Kelly D. Brownell (Editor), et al (1986); ISBN: 0465028624; http://www.amazon.com/exec/obidos/ASIN/0465028624/icongroupin terna

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Health Food Junkies: Overcoming the Obession With Healthful Eating by Steven, Md. Bratman, David Knight (1901); ISBN: 0767906306; http://www.amazon.com/exec/obidos/ASIN/0767906306/icongroupin terna

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Hunger Strike: The Anorectic's Struggle As a Metaphor for Our Age by Susie Orbach (1986); ISBN: 0393022781; http://www.amazon.com/exec/obidos/ASIN/0393022781/icongroupin terna

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Obesity : Behavioral Approaches to Dietary Management by Ben J. Williams (1976); ISBN: 0876301154; http://www.amazon.com/exec/obidos/ASIN/0876301154/icongroupin terna

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Occupational Therapy for People With Eating Dysfunctions by Florence Cromwell (Editor) (1986); ISBN: 0866565892; http://www.amazon.com/exec/obidos/ASIN/0866565892/icongroupin terna

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On the Way to Self: Ego and Early Oedipal Development by Johanna Krout Tabin (1985); ISBN: 0231059442; http://www.amazon.com/exec/obidos/ASIN/0231059442/icongroupin terna

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Owl Was a Baker's Daughter : Obesity, Anorexia Nervosa, and the Repressed Feminine--A Psychological Study (139P) by Marion Woodman (1985); ISBN: 0919123031; http://www.amazon.com/exec/obidos/ASIN/0919123031/icongroupin terna

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Pharmacology of Eating Disorders: Theoretical and Clinical Developments by Michele O. Carruba (1986); ISBN: 0881672017; http://www.amazon.com/exec/obidos/ASIN/0881672017/icongroupin terna

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Practical Comprehensive Treatment of Anorexia Nervosa and Bulimia (Johns Hopkins Series in Contemporary Medicine and Public Health) by Arnold E., M.D. Andersen (1984); ISBN: 0801824427; http://www.amazon.com/exec/obidos/ASIN/0801824427/icongroupin terna

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Starving Women: A Psychology of Anorexia Nervosa by Angelyn Spignesi (1983); ISBN: 0882143255; http://www.amazon.com/exec/obidos/ASIN/0882143255/icongroupin terna

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The Eating Sickness: Anorexia, Bulimia and the Myth of Suicide by Slimming by Jill Welbourne, Joan Purgold (1984); ISBN: 0710804784; http://www.amazon.com/exec/obidos/ASIN/0710804784/icongroupin terna

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The Evaluation and Treatment of Eating Disorders (1986); ISBN: 0866565418; http://www.amazon.com/exec/obidos/ASIN/0866565418/icongroupin terna

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The Monster Within: Overcoming Bulimia by Cynthia Rowland, Paul D. Meier (Contributor) (1984); ISBN: 0801077311; http://www.amazon.com/exec/obidos/ASIN/0801077311/icongroupin terna

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The Psychobiology of Anorexia Nervosa by K.M. and Ploog, D. Pirke (Editor) (1984); ISBN: 0387131965; http://www.amazon.com/exec/obidos/ASIN/0387131965/icongroupin terna

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Theory and Treatment of Anorexia Nervosa and Bulimia: Biomedical, Sociocultural, and Psychological Perspectives by Steven W. Emmett (Editor) (1985); ISBN: 087630384X; http://www.amazon.com/exec/obidos/ASIN/087630384X/icongroupi nterna

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Treating Eating Disorders: Obesity, Anorexia Nervosa, and Bulimia by Gloria Rakita Leon (1984); ISBN: 0866160264; http://www.amazon.com/exec/obidos/ASIN/0866160264/icongroupin terna

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Understanding Anorexia Nervosa by Felicia F. Romeo (1986); ISBN: 0398051917;



When Food Is a Four Letter Word by Paul Haskew (1984); ISBN: 013956103X; http://www.amazon.com/exec/obidos/ASIN/013956103X/icongroupi nterna

The National Library of Medicine Book Index The National Library of Medicine at the National Institutes of Health has a massive database of books published on healthcare and biomedicine. Go to the following Internet site, http://locatorplus.gov/, and then select “Search LOCATORplus.” Once you are in the search area, simply type “binge eating disorder” (or synonyms) into the search box, and select “books only.” From there, results can be sorted by publication date, author, or relevance. The following was recently catalogued by the National Library of Medicine:25 ·

Are Americans on a consumption binge?: The evidence reconsidered. Author: R.A. Blecker; Year: 1990; Washington, D.C., Economic Policy Institute, 1990

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Binge eating: nature, assessment, and treatment. Author: Christopher G. Fairburn, G. Terence Wilson, editors; Year: 1993; New York: Guilford Press, c1993; ISBN: 0898629950 (alk. paper) http://www.amazon.com/exec/obidos/ASIN/0898629950/icongroupin terna

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Binge-purge syndrome: diagnosis, treatment, and research. Author: Raymond C. Hawkins II, William J. Fremouw, Pamelia F. Clement, editors; Year: 1984; New York: Springer Pub. Co., c1984; ISBN: 0826140203 http://www.amazon.com/exec/obidos/ASIN/0826140203/icongroupin terna

In addition to LOCATORPlus, in collaboration with authors and publishers, the National Center for Biotechnology Information (NCBI) is adapting biomedical books for the Web. The books may be accessed in two ways: (1) by searching directly using any search term or phrase (in the same way as the bibliographic database PubMed), or (2) by following the links to PubMed abstracts. Each PubMed abstract has a “Books” button that displays a facsimile of the abstract in which some phrases are hypertext links. These phrases are also found in the books available at NCBI. Click on hyperlinked results in the list of books in which the phrase is found. Currently, the majority of the links are between the books and PubMed. In the future, more links will be created between the books and other types of information, such as gene and protein sequences and macromolecular structures. See http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Books.

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Books 83

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Bodily discourses: when students write about abuse and eating disorders. Author: Michelle Payne; Year: 2000; Portsmouth, NH: Boynton/Cook Publishers, c2000; ISBN: 0867094710 (alk. paper) http://www.amazon.com/exec/obidos/ASIN/0867094710/icongroupin terna

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Bulimarexia: the binge. Author: purge cycle / Marlene Boskind-White, William C. White, Jr; Year: 1987; New York: Norton, c1987; ISBN: 0393023680 http://www.amazon.com/exec/obidos/ASIN/0393023680/icongroupin terna

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Bulimia, a guide to recovery: understanding & overcoming the bingepurge syndrome. Author: Lindsey Hall & Leigh Cohn; Year: 1986; Santa Barbara: Gurze Books, c1986; ISBN: 0936077050 http://www.amazon.com/exec/obidos/ASIN/0936077050/icongroupin terna

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Bulimia, the binge-purge compulsion. Author: Janice M. Cauwels; Year: 1983; Garden City, N.Y.: Doubleday & Co., c1983; ISBN: 0385183771 http://www.amazon.com/exec/obidos/ASIN/0385183771/icongroupin terna

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Bulimia. Author: anorexia: the binge/purge cycle and self-starvation / Marlene Boskind-White, William C. White, Jr; Year: 2000; New York: W.W. Norton & Co., c2000; ISBN: 0393048411 http://www.amazon.com/exec/obidos/ASIN/0393048411/icongroupin terna

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Can't eat, won't eat: dietary difficulties and autistic spectrum disorders. Author: Brenda Legge; Year: 2002; London; Philadelphia: Jessica Kingsley Publishers, 2002; ISBN: 1853029742 (alk. paper) http://www.amazon.com/exec/obidos/ASIN/1853029742/icongroupin terna

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Challenges in clinical practice: pharmacologic and psychosocial strategies. Author: edited by Mark H. Pollack, Michael W. Otto, Jerrold F. Rosenbaum; Year: 1996; New York: Guilford Press, c1996; ISBN: 1572300671 (alk. paper) http://www.amazon.com/exec/obidos/ASIN/1572300671/icongroupin terna

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Clinician's guide to Getting better bit(e) by bit(e): a survival kit for sufferers of bulimia nervosa and binge eating disorders. Author: Ulrike Schmidt and Janet Treasure; Year: 1997; Hove, East Sussex, UK: Psychology Press, c1997; ISBN: 0863777309 http://www.amazon.com/exec/obidos/ASIN/0863777309/icongroupin terna


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Cost of competence: why inequality causes depression, eating disorders, and illness in women. Author: Brett Silverstein and Deborah Perlick; Year: 1995; New York: Oxford University Press, 1995; ISBN: 0195069862 http://www.amazon.com/exec/obidos/ASIN/0195069862/icongroupin terna

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Counselling for eating disorders. Author: Sara Gilbert; Year: 2000; London; Thousand Oaks, Calif.: SAGE Publications, 2000; ISBN: 0803977247 http://www.amazon.com/exec/obidos/ASIN/0803977247/icongroupin terna

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Dying to drink: confronting binge drinking on college campuses. Author: Henry Wechsler and Bernice Wuethrich; Year: 2002; Emmaus, Pa.: Rodale, c2002; ISBN: 1579545831 (hardcover) http://www.amazon.com/exec/obidos/ASIN/1579545831/icongroupin terna

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Eating disorder in a Nordic perspective: explanatory models and therapeutic strategies. Author: editors, Hans H. BassØe, Jon Chr. Laberg, Liv Opstvedt; Year: 1990; Copenhagen: Munksgaard, [1990]; ISBN: 8716148908

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Eating disorder sourcebook: a comprehensive guide to the cause, treatments, and prevention of eating disorders. Author: Carolyn Costin; Year: 1999; Los Angeles, CA: Lowell House; Chicago: Contemporary Books, 1999; ISBN: 0737301023 (pbk.) http://www.amazon.com/exec/obidos/ASIN/0737301023/icongroupin terna

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Eating disorders: innovative directions for research and practice. Author: edited by Ruth H. Striegel-Moore and Linda Smolak; Year: 2001; Washington, DC: American Psychological Association, c2001; ISBN: 1557987785 http://www.amazon.com/exec/obidos/ASIN/1557987785/icongroupin terna

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Eating disorders: providing effective recreational therapy interventions. Author: Dayna Miller and Laurie Jake; Year: 2001; Ravensdale, WA: Idyll Arbor, c2001; ISBN: 1882883470 (alk. paper)

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Eating disorders sourcebook: basic consumer health information about eating disorders, including information about anorexia nervosa, bulimia nervosa, binge eating, body dysmorphic disorder, pica, laxative abuse, and night eating syndrome: along with inf. Author: Schmidt, Ulrike; Year: 2001; Detroit, MI: Omnigraphics, c2001; ISBN: 0780803353 (alk. paper)

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Emotion and emotional disorders: reports on First Maudsley Conference on New Developments in Psychiatry, London, July 19-24, 1987. Author: by Bill Breckon, with foreword by Jeffrey Gray and Isaac Marks; Year: 1988; Basle, Switzerland: Editiones (Roche), c1988

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Excessive appetites: a psychological view of addictions. Author: Jim Orford; Year: 2001; Chichester; New York: Wiley, c2001; ISBN: 0471982318 (pbk.) http://www.amazon.com/exec/obidos/ASIN/0471982318/icongroupin terna

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Food for thought: the sourcebook for obesity and eating disorders. Author: Dana K. Cassell; foreward [sic] by David H. Gleaves; Year: 2001; New York: Checkmark Books, c2001; ISBN: 0816041474 (pbk.: alk. paper) http://www.amazon.com/exec/obidos/ASIN/0816041474/icongroupin terna

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New hope for binge eaters: advances in the understanding and treatment of bulimia. Author: Harrison G. Pope, Jr. and James I. Hudson; Year: 1984; New York: Harper & Row, c1984; ISBN: 0060152338 http://www.amazon.com/exec/obidos/ASIN/0060152338/icongroupin terna

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Nutrition counseling in the treatment of eating disorders. Author: Marcia Herrin; Year: 2002; New York: Brunner-Routledge, 2002; ISBN: 158391031X (hardcover) http://www.amazon.com/exec/obidos/ASIN/158391031X/icongroupi nterna

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Ordinance and code regulating eating and drinking establishments. Author: recommended by the U.S. Public Health Service; Year: 1938; [Washington, D.C.] The Service, [1938]

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Outpatient treatment of eating disorders: a guide for therapists, dietitians, and physicians. Author: James E. Mitchell, editor; Year: 2001; Minneapolis: University of Minnesota Press, c2001; ISBN: 0816637180 (HC: alk. paper) http://www.amazon.com/exec/obidos/ASIN/0816637180/icongroupin terna

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Parent's guide to anorexia and bulimia: understanding and helping self-starvers and binge. Author: purgers / by Katherine Byrne; with an afterword bu Bernard Mackler; Year: 1987; New York: Shocken Books, 1987; ISBN: 0805240322



Pre-feeding skills: a comprehensive resource for mealtime development. Author: Suzanne Evans Morris, Marsha Dunn Klein; foreword by Ellyn Satter; Year: 2000; [Tucson, Ariz.?]: Therapy Skill Builders, c2000; ISBN: 0761674071 http://www.amazon.com/exec/obidos/ASIN/0761674071/icongroupin terna

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Sensing the self: women's recovery from bulimia. Author: Sheila M. Reindl; Year: 2001; Cambridge, Mass.: Harvard University Press, 2001; ISBN: 0674004876 http://www.amazon.com/exec/obidos/ASIN/0674004876/icongroupin terna

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What do eating disorder patients expect of treatment?: development of a new assessment method. Author: David N. Clinton; Year: 1994; Stockholm: Dept. of Psychology, Stockholm University, [1994]

Chapters on Binge Eating Disorder Frequently, binge eating disorder will be discussed within a book, perhaps within a specific chapter. In order to find chapters that are specifically dealing with binge eating disorder, an excellent source of abstracts is the Combined Health Information Database. You will need to limit your search to book chapters and binge eating disorder using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find book chapters, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Book Chapter.” By making these selections and typing in “binge eating disorder” (or synonyms) into the “For these words:” box, you will only receive results on chapters in books. The following is a typical result when searching for book chapters on binge eating disorder: ·

Eating Disorders in Women Source: in Nutritional Concerns of Women. Wolinski, I.; KlimisTavantzis, D; eds. Boca Raton, FL, CRC Press, pp. 111-133, 1996. Contact: CRC Press LLC, 2000 Corporate Blvd., NW., Boca Raton, FL 33431. Summary: Eating Disorders in Women, a chapter in Nutritional Concerns of Women, reviews the diagnostic criteria, epidemiology, characteristics,

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medical complications, and nutritional complications/nutritional treatment of the two major classifications of eating disorders, anorexia nervosa (AN) and bulimia nervosa (BN). The following features must be present in an individual diagnosed with AN: Refusal to maintain a minimally normal body weight for age and height or failure to make expected gains during periods of growth, intense fear of gaining weight or becoming fat even though not overweight, disturbance of body image, and the absence of at least three consecutive menstrual cycles in premenopausal women. The following criteria must be present for the diagnosis of BN: Recurrent episodes of binge eating, recurrent abnormal behavior to prevent weight gain from binging, the binging and compensatory activities occur at least twice a week for 3 months, and self worth is overly influenced by body shape and weight. The prevalence of eating disorders is reported to be increasing, ranging from 1 to 4 percent of adolescent and young adult women. These disorders have high rates of psychiatric comorbidity. Many bulimics have impulsive behaviors that include shopping sprees, promiscuity, self-mutilation, and shoplifting. A 33-year study of AN reported a crude mortality rate of 18 percent, making this disorder the deadliest of any psychiatric disorder. Some of the most severe complications involve the cardiovascular system. Gastroenterologic complications are common and varied, often involving the entire digestive tract from the mouth to the rectum, and frequently interfering with nutritional rehabilitation. Renal complications in AN patients include a decreased glomerular filtration rate and concentrating ability, increased blood urea nitrogen, electrolyte abnormalities, pitting edema, and hypokalemic nephropathy. Numerous endocrine changes occur that are probably related to low body fat, as well as psychological factors. Hematologic complications include a mild anemia and thrombocytopenia in one third of patients and leukopenia in two thirds of patients. Skeletal complications, dermatological, and dental complications are also described. The following nutritional deficiencies are highlighted: water soluble vitamins, vitamin A and carotenoids, vitamin E, vitamin K, zinc, and copper. Most patients with BN can be treated as outpatients unless there is severe dehydration and/or metabolic alterations needing hospitalization. The best outcome in AN patients is related to weight restoration and resumption of normal eating behavior. In both conditions it is important to understand the underlying metabolic status and energy requirements. 93 references. ·

Identifying and Treating Eating Disorders in Persons with Diabetes Mellitus Source: in Powers, M.A., ed. Handbook of Diabetes Medical Nutrition Therapy. Gaithersburg, MD: Aspen Publishers, Inc. 1996. p. 585-601.


Contact: Available from Aspen Publishers. P.O. Box 990, Frederick, MD 21705-9727. (800) 638-8437. Fax (301) 695-7931. PRICE: $89.00. ISBN: 0834206315. Summary: In this chapter, from a handbook on diabetes medical nutrition therapy (MNT), the author reviews the research in identifying and treating eating disorders in persons with diabetes mellitus. After an overview of clinical and subclinical eating disorders, the author covers the prevalence of disordered eating in IDDM; dysfunctional eating attitudes; clinical eating disorders; the intentional omission of insulin; the medical consequences of disordered eating in IDDM and in NIDDM; contributors to disordered eating in diabetes; identifying disordered eating; treatment issues including hospitalization, negotiated diabetes management, and outpatient psychotherapy; and treatment and prevention tips. 1 figure. 64 references. ·

Preventing Eating Disorders in Young Women With Type I Diabetes Source: in Anderson, B.J. and Rubin, R.R., eds. Practical Psychology for Diabetes Clinicians: How to Deal with the Key Behavioral Issues Faced by Patients and Health Care Teams. Alexandria, VA: American Diabetes Association. 1996. p. 133-141. Contact: Available from American Diabetes Association. Order Fulfillment Department, P.O. Box 930850, Atlanta, GA 31193-0850. (800) 232-6733. Fax (404) 442-9742. PRICE: $19.95 (members); $24.95 (nonmembers). ISBN: 0945448732. Summary: This chapter, from a guidebook on behavioral issues for diabetes clinicians, provides a framework for preventing eating disorders in young women with diabetes. The authors focus on some of the early warning signs of eating disorders, as well as on strategies that health care providers can use to help prevent disordered eating in their patients. Strategies for primary prevention include addressing the drive for thinness and body dissatisfaction; deemphasizing diet and dieting; counseling patients about the need for control and expression of negative feelings about diabetes management; helping with conflict over normal developmental struggles; addressing metabolic reactivity; involving the family; and facilitating empowerment. The authors encourage readers to teach patients to become critical thinkers, to develop successful coping strategies for dealing with the stress of diabetes, and to avoid associating body image or glucose control with success, intelligence, or achievement. 7 references.

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General Home References In addition to references for binge eating disorder, you may want a general home medical guide that spans all aspects of home healthcare. The following list is a recent sample of such guides (sorted alphabetically by title; hyperlinks provide rankings, information, and reviews at Amazon.com): · The 21st Century Complete Medical Guide to Obesity and Weight Control, Dieting, Nutrition, Fat, Meal Plans and Activities: Authoritative Federal Government Documents, Clinical References, and Practical Information for Patients and Physicians by PM Medical Health News; CD-ROM, 29289 pages (February 18, 2002), Progressive Management; ISBN: 1931828180; http://www.amazon.com/exec/obidos/ASIN/1931828180/icongroupinterna · A Complete Guide to Obesity Surgery: Everything You Need to Know About Weight Loss Surgery and How to Succeed by Bryan G. Woodward; Paperback (June 2001), Trafford; ISBN: 1552126641; http://www.amazon.com/exec/obidos/ASIN/1552126641/icongroupinterna · The Diet Alternative : With Study Guide by Diane Hampton; Paperback February 2002), Whitaker House; ISBN: 0883687216; http://www.amazon.com/exec/obidos/ASIN/0883687216/icongroupinterna · Fat No More: The Answer for the Dangerously Overweight by Norman B. Ackerman; Paperback: 250 pages; (August 1999), Prometheus Books; ISBN: 1573926922; http://www.amazon.com/exec/obidos/ASIN/1573926922/icongroupinterna · Understanding Obesity: The Five Medical Causes (Your Personal Health) by Dr. Lance Levy; Paperback: 200 pages; (August 5, 2000), Key Porter Books; ISBN: 1552094790; http://www.amazon.com/exec/obidos/ASIN/1552094790/icongroupinterna

Vocabulary Builder Comorbidity: The presence of co-existing or additional diseases with reference to an initial diagnosis or with reference to the index condition that is the subject of study. Comorbidity may affect the ability of affected individuals to function and also their survival; it may be used as a prognostic indicator for length of hospital stay, cost factors, and outcome or survival. [NIH]

Dehydration: The condition that results from excessive loss of body water. Called also anhydration, deaquation and hypohydration. [EU]


Edema: Excessive amount of watery fluid accumulated in the intercellular spaces, most commonly present in subcutaneous tissue. [NIH] Filtration: The passage of a liquid through a filter, accomplished by gravity, pressure, or vacuum (suction). [EU] Glomerular: Pertaining to or of the nature of a glomerulus, especially a renal glomerulus. [EU] Hyperlipidemia: An excess of lipids in the blood. [NIH] Kinetic: Pertaining to or producing motion. [EU] Nephropathy: Disease of the kidneys. [EU] Nitrogen: An element with the atomic symbol N, atomic number 7, and atomic weight 14. Nitrogen exists as a diatomic gas and makes up about 78% of the earth's atmosphere by volume. It is a constituent of proteins and nucleic acids and found in all living cells. [NIH] Outpatients: Persons who receive ambulatory care at an outpatient department or clinic without room and board being provided. [NIH] Thrombocytopenia: Decrease in the number of blood platelets. [EU]

Multimedia 91

CHAPTER 6. MULTIMEDIA ON BINGE EATING DISORDER Overview Information on binge eating disorder can come in a variety of formats. Among multimedia sources, video productions, slides, audiotapes, and computer databases are often available. In this chapter, we show you how to keep current on multimedia sources of information on binge eating disorder. We start with sources that have been summarized by federal agencies, and then show you how to find bibliographic information catalogued by the National Library of Medicine. If you see an interesting item, visit your local medical library to check on the availability of the title.

Video Recordings Most diseases do not have a video dedicated to them. If they do, they are often rather technical in nature. An excellent source of multimedia information on binge eating disorder is the Combined Health Information Database. You will need to limit your search to “video recording” and “binge eating disorder” using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find video productions, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Videorecording (videotape, videocassette, etc.).” By making these selections and typing “binge eating disorder” (or synonyms) into the “For these words:” box, you will only receive results on video productions. The following is a typical result when searching for video recordings on binge eating disorder:


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Eating Disorders: Prevention and Treatment Source: Bethesda, MD: National Institute of Diabetes and Digestive and Kidney Diseases, 1992, 60 minutes. Contact: WIN, 1 WIN WAY, Bethesda, MD 20892-3665. Summary: In this lecture, Dr. Marcus presents an overview of eating disorders, their clinical course and outcome, and their causes and treatment. The American Psychological Association lists three common eating disorders: anorexia nervosa, bulimia nervosa, and eating disorders not otherwise specified (EDNOS). Anorexia nervosa, in which the patient typically maintains 80 percent of normal weight and has an intense fear of gaining weight and being fat, is divided into the restricting type and the binge eating/purging type. Bulimia, which is characterized by recurrent episodes of binges and inappropriate compensatory behaviors at least two times a week over a 3-month period, is divided into purging and nonpurging types. EDNOS include patients with anorexia nervosa but with normal weight and patients with all bulimia criteria but with fewer binges and inappropriate behaviors. The EDNOS most often associated with obesity is binge-eating disorder, in which patients have recurrent episodes of eating more rapidly than normal, eating until uncomfortably full, eating large amounts when not hungry, and eating alone. Dr. Marcus notes that the causes of eating disorders are multifactorial and describes biologic, psychological, family, and sociologic and cultural factors. She emphasizes promoting self-esteem in young women as an important prevention measure. Dr. Marcus also stresses that cognitive behavior therapy, which is symptom focused, is superior for treatment of all eating disorders. Interpersonal therapy is a structured treatment also used. She describes both therapies as well as antidepressant treatment and combination treatments.

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When Food is an Obsession: Overcoming Eating Disorders Source: HRM Videos. 28 min. 1995. Contact: HRM Videos. $189. (800) 431-2050. Summary: This video discusses eating disorders, utilizing interviews with adolescents suffering from eating disorders and their parents, combined with factual information.

Multimedia 93

Bibliography: Multimedia on Binge Eating Disorder The National Library of Medicine is a rich source of information on healthcare-related multimedia productions including slides, computer software, and databases. To access the multimedia database, go to the following Web site: http://locatorplus.gov/. Select “Search LOCATORplus.” Once in the search area, simply type in binge eating disorder (or synonyms). Then, in the option box provided below the search box, select “Audiovisuals and Computer Files.” From there, you can choose to sort results by publication date, author, or relevance. The following multimedia has been indexed on binge eating disorder. For more information, follow the hyperlink indicated: ·

Alzheimer's disease : natural feeding techniques. Source: Department of Veterans Affairs; produced by Employee Education Network, Northport Special Projects Group, Washington National Media Development Center for the Geriatric Research Educatio; Year: 1993; Format: Videorecording; [Washington, D.C.]: Dept. of Veterans Affairs, [1993]

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Bulimia : the binge and purge syndrome. Source: [presented by] MEES; a production of DAP Associates; Year: 1983; Format: Videorecording; [Los Angeles, Calif.]: Hospital Satellite Network, c1983

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Cathy Rigby on eating disorders. Source: College Hospital; a McCoy Rigby Entertainment production; Year: 1988; Format: Videorecording; [Huntington Beach, Calif.]: College Health Enterprises, c1988

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Dimensions in feeding techniques. Source: [presented by] Anderson Benner Productions; Year: 1991; Format: Videorecording; Woodlands, TX: Anderson Benner, c1991

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Early adulthood. Special problems. Source: [presented by] Magna Systems, Inc.; written & produced by Max Pictures, Inc. for Magna Systems, Inc; Year: 1999; Format: Videorecording; Barrington, IL: Magna Systems, c1999

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Eating disorders : diagnosis, management, and the law. Source: a coproduction of Multimedia Communications and Physician Education and Development; Year: 2001; Format: Videorecording; Oakland, CA: Kaiser Foundation Health Plan, c2001

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Eating disorders : new approaches to treatment. Source: a presentation of Films for the Humanities & Sciences; a Dartmouth-Hitchcock Medical Center production; Year: 2000; Format: Videorecording; Princeton, NJ: Films for the Humanities & Sciences, c2000


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Eating disorders : recorded at DDW 1995 in San Diego. Source: AGA, American Gastroenterological Association; Year: 1995; Format: Sound recording; [Bethesda, Md.]: The Association, [1995?]

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Eating disorders : this illness is not just about food. Source: a production of Dartmouth-Hitchcock Medical Center; Year: 2000; Format: Videorecording; Sherborn, MA: Aquarius Health Care Videos, c2000

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Eating disorders . Year: 1998; Format: Videorecording; [Irvine, Calif.]: CME, 1998

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Fad diets. Source: a co-production of Multimedia Communications and Physician Education and Development; Year: 2000; Format: Videorecording; Oakland, CA: Kaiser Foundation Health Plan, c2000

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Famine within. Source: [presented by] Direct Cinema Limited; a film by Katherine Gilday; produced with the participation of Telefilm Canada ... [et al.]; produced by Kandor Productions Ltd; Year: 1990; Format: Videorecording; Santa Monica, CA: Direct Cinema, c1990

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Homeopathic treatment of eating disorders. Source: Nat'l. Center for Homeopathy, Los Angeles 1990; Year: 1990; Format: Sound recording; [United States: The Center?, 1990?]

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Hormone therapy in young women with irregular menses. Source: with Michelle P. Warren; Year: 1986; Format: Videorecording; Secaucus, N.J.: Network for Continuing Medical Education, 1986

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Integrated response to a meal. Source: [authors, Stephen Pandol, Helen E. Raybould; produced by American Gastroenterological Association]; Year: 1995; Format: Slide; [Bethesda, Md.]: American Gastroenterological Association, c1995

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Mental health. Source: [presented by] Journal of women's health; Year: 1993; Format: Videorecording; Bethesda, Md.: BioConferences International, c1993

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Mirror for the heart : facing eating disorders. Source: produced with the participation of SCN, SaskFILM; co-production between Heartland Motion Pictures Inc. ... [et al.]; Year: 1994; Format: Videorecording; [Mississauga, Ont.]: Medical Audio Visual Communications, 1994

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Nutrition for living. Source: a presentation of Films for the Humanities & Sciences; a production of Films for the Humanities and Sciences & Benjamin/Cummings Publishing; Year: 1994; Format: Videorecording; Princeton, N.J.: Films for the Humanities & Sciences, c1994

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Overcoming binge eating disorder and compulsive eating . Year: 2001; Format: Videorecording; Carrollton, TX: HSTN, c2001

Multimedia 95

·

Psychosomatic conditions : obesity. Source: produced by Robert Anderson Associates Limited; Year: 1963; Format: Motion picture; Canada: [s.n., 1963]

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Recovering bodies : overcoming eating disorders. Source: Media Education Foundation; Year: 1997; Format: Videorecording; Northamption, MA: The Foundation, c1997

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Shadows and lies. Source: Windborne Productions; Year: 1999; Format: Videorecording; Boston, MA: Fanlight Productions [distributor], c1999

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Silent hunger : anorexia and bulimia. Source: [presented by] Films for the Humanities & Sciences; produced with the assistance of the National Agenda for Women's Grants Program, Office of the Status of Women; Year: 1995; Format: Videorecording; Princeton, N.J.: Films for the Humanities & Sciences, c1995

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Slim hopes : advertising and the obsession with thinness. Source: a production of the Media Education Foundation; Year: 1995; Format: Videorecording; [Northampton, Mass.]: The Foundation, c1995

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Stop the weight elevator : a video self-help guide for control of compulsive overeating. Source: Health Sciences Consortium; Year: 1993; Format: Videorecording; Chapel Hill, N.C.: Health Sciences Consortium, 1993

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Stop the weight elevator : a video self-help guide for control of compulsive overeating. Year: 1993; Format: Videorecording; Chapel Hill, NC: Health Sciences Consortium, 1993

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Thin at any cost : treating eating disorders. Source: a presentation of Films for the Humanities & Sciences, ABC News Productions; Year: 2001; Format: Videorecording; Princeton, N.J.: Films for the Humanities & Sciences, c2001

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When food is the enemy : eating disorders. Source: Meridian Education Corp; Year: 2000; Format: Videorecording; Bloomington, IL: Meridian Education Corp., c2000

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Women & nutrition. Source: [presented by] American College of Obstetricians & Gynecologists; produced by Ciné-Med; Year: 1996; Format: Videorecording; Washington, DC: The College, 1996

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Working with eating disorders : cognitive-behavioral approach. Source: [presented by] Zeig, Tucker & Co., Inc.; produced by Communication Services, Governors State University; Year: 1999; Format: Videorecording; Phoenix, AZ: Zeig, Tucker & Co., [1999]


Vocabulary Builder Obsession: A recurrent, persistent thought, image, or impulse that is unwanted and distressing (ego-dystonic) and comes involuntarily to mind despite attempts to ignore or suppress it. Common obsessions involve thoughts of violence, contamination, and self-doubt. [EU]

Periodicals and News 97

CHAPTER 7. PERIODICALS AND NEWS ON BINGE EATING DISORDER Overview Keeping up on the news relating to binge eating disorder can be challenging. Subscribing to targeted periodicals can be an effective way to stay abreast of recent developments on binge eating disorder. Periodicals include newsletters, magazines, and academic journals. In this chapter, we suggest a number of news sources and present various periodicals that cover binge eating disorder beyond and including those which are published by patient associations mentioned earlier. We will first focus on news services, and then on periodicals. News services, press releases, and newsletters generally use more accessible language, so if you do chose to subscribe to one of the more technical periodicals, make sure that it uses language you can easily follow.

News Services & Press Releases Well before articles show up in newsletters or the popular press, they may appear in the form of a press release or a public relations announcement. One of the simplest ways of tracking press releases on binge eating disorder is to search the news wires. News wires are used by professional journalists, and have existed since the invention of the telegraph. Today, there are several major “wires” that are used by companies, universities, and other organizations to announce new medical breakthroughs. In the following sample of sources, we will briefly describe how to access each service. These services only post recent news intended for public viewing.


PR Newswire Perhaps the broadest of the wires is PR Newswire Association, Inc. To access this archive, simply go to http://www.prnewswire.com. Below the search box, select the option “The last 30 days.” In the search box, type “binge eating disorder” or synonyms. The search results are shown by order of relevance. When reading these press releases, do not forget that the sponsor of the release may be a company or organization that is trying to sell a particular product or therapy. Their views, therefore, may be biased. Reuters The Reuters’ Medical News database can be very useful in exploring news archives relating to binge eating disorder. While some of the listed articles are free to view, others can be purchased for a nominal fee. To access this archive, go to http://www.reutershealth.com/frame2/arch.html and search by “binge eating disorder” (or synonyms). The following was recently listed in this archive for binge eating disorder: ·

Phentermine/fluoxetine adds little to the treatment of binge eating disorder Source: Reuters Medical News Date: October 06, 2000 http://www.reuters.gov/archive/2000/10/06/professional/links/20001 006clin014.html

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Binge eating disorder is distinct from bulimia nervosa Source: Reuters Medical News Date: August 14, 2000 http://www.reuters.gov/archive/2000/08/14/professional/links/20000 814clin022.html

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Eating disorders prevalent in patients with type 2 diabetes Source: Reuters Medical News Date: July 14, 1998 http://www.reuters.gov/archive/1998/07/14/professional/links/19980 714epid001.html

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Navy Men On Active Duty At Risk Of Eating Disorders Source: Reuters Medical News Date: December 01, 1997 http://www.reuters.gov/archive/1997/12/01/professional/links/19971 201epid001.html


The NIH Within MEDLINEplus, the NIH has made an agreement with the New York Times Syndicate, the AP News Service, and Reuters to deliver news that can be browsed by the public. Search news releases at http://www.nlm.nih.gov/medlineplus/alphanews_a.html. MEDLINEplus allows you to browse across an alphabetical index. Or you can search by date at http://www.nlm.nih.gov/medlineplus/newsbydate.html. Often, news items are indexed by MEDLINEplus within their search engine. The following was recently indexed as relating to binge eating disorder: ·

'Sleep Eaters' Hit the Kitchen When Slumbering http://www.nlm.nih.gov/medlineplus/news/fullstory_7922.html

Business Wire Business Wire is similar to PR Newswire. To access this archive, simply go to http://www.businesswire.com. You can scan the news by industry category or company name.

Internet Wire Internet Wire is more focused on technology than the other wires. To access this site, go to http://www.internetwire.com and use the “Search Archive” option. Type in “binge eating disorder” (or synonyms). As this service is oriented to technology, you may wish to search for press releases covering diagnostic procedures or tests that you may have read about. Search Engines Free-to-view news can also be found in the news section of your favorite search engines (see the health news page at Yahoo: http://dir.yahoo.com/Health/News_and_Media/, or use this Web site’s general news search page http://news.yahoo.com/. Type in “binge eating disorder” (or synonyms). If you know the name of a company that is relevant to binge eating disorder, you can go to any stock trading Web site (such as www.etrade.com) and search for the company name there. News items across various news sources are reported on indicated hyperlinks.


BBC Covering news from a more European perspective, the British Broadcasting Corporation (BBC) allows the public free access to their news archive located at http://www.bbc.co.uk/. Search by “binge eating disorder” (or synonyms).

Newsletters on Binge Eating Disorder Given their focus on current and relevant developments, newsletters are often more useful to patients than academic articles. You can find newsletters using the Combined Health Information Database (CHID). You will need to use the “Detailed Search” option. To access CHID, go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. Your investigation must limit the search to “Newsletter” and “binge eating disorder.” Go to the bottom of the search page where “You may refine your search by.” Select the dates and language that you prefer. For the format option, select “Newsletter.” By making these selections and typing in “binge eating disorder” or synonyms into the “For these words:” box, you will only receive results on newsletters. The following list was generated using the options described above: ·

American Anorexia and Bulimia Association Newsletter Source: New York, NY: American Anorexia and Bulimia Association, Inc. (AABA). 1995. [10 p. average]. Contact: Available from American Anorexia and Bulimia Association, Inc. (AABA). 293 Central Park West, Suite 1R, New York, NY 10024. (212) 501-8351; FAX (212) 501-0342. PRICE: Free with membership. Summary: This newsletter presents information about eating disorders and highlights the activities of the American Anorexia and Bulimia Association, Inc. (AABA). A typical issue includes personal essays, conference and meeting highlights, programs and activities of the AABA, publication reviews, treatment updates, and a list of new AABA support groups throughout the United States.

·

Working Together Source: Highland Park, IL: National Association of Anorexia Nervosa and Associated Disorders (ANAD). 1994. 4 p. (average). Contact: Available from National Association of Anorexia Nervosa and Associated Disorders (ANAD). Box 7, Highland Park, IL 60035. (708) 8313438; FAX (708) 433-4632. PRICE: Free with membership.


Summary: This newsletter is designed to help individuals with eating disorders. The newsletter has articles on specific strategies for alleviating the problems of eating disorders.

Newsletter Articles If you choose not to subscribe to a newsletter, you can nevertheless find references to newsletter articles. We recommend that you use the Combined Health Information Database, while limiting your search criteria to “newsletter articles.” Again, you will need to use the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. Go to the bottom of the search page where “You may refine your search by.” Select the dates and language that you prefer. For the format option, select “Newsletter Article.” By making these selections, and typing in “binge eating disorder” (or synonyms) into the “For these words:” box, you will only receive results on newsletter articles. You should check back periodically with this database as it is updated every 3 months. The following is a typical result when searching for newsletter articles on binge eating disorder: ·

Medication Treatments for Binge Eating Disorder Source: Weight Control Digest. 7(4):633, 636-639; July/Aug 1997. Contact: Weight Control Digest, 1555 W. Mockingbird Lane, Suite 203, Dallas, TX 75235. (800) 736-7323. Summary: This article examines the use of medications in treating overweight individuals with binge eating disorder. The authors first describe what binge eating disorder (BED) is, and how it differs from the bingeing and purging syndrome. They then review studies done with antidepressants, appetite suppressants, combinations of these medications and psychotherapy, and behavior modification. The authors then offer guidelines for the use of medications in the treatment of BED and suggest what the future treatment of BED might be. They conclude that any treatment plan for BED should include medication, behavior modification, and diet and lifestyle changes.

·

Study Suggests Anti-Nausea Drug May Treat Bulimia Source: WIN Notes. p. 6. Fall 2000. Contact: Weight-control Information Network. 1-877-WIN-4627.


Summary: Odansetron, used for the prevention of nausea and vomiting caused by cancer chemotherapy, may be helpful in the treatment of bulimia nervosa. A study by Dr. Patricia L. Faris and coworkers from the University of Minneapolis Medical School published in the March 4, 2000, issue of The Lancet reports the study in which 26 patients with bulimia nervosa were given either odansetron or a placebo. Results indicated a significant improvement in the odansetron group. The binge/vomit episodes averaged 13.2 per week in the placebo group versus 6.5 per week in the drug group. The odansetron group demonstrated improvement in the number of normal meals and snacks eaten and a decrease in the time spent in bulimic behaviors. However, questions remain about odansetron as a treatment option for bulimia. Long-term safety has not been established, and it does not improve other bulimic symptoms such as poor body image or depression. The article notes the need for further research before odansetron is recommended for the treatment of bulimia. ·

Eating Disorders of Men and Women: The Therapeutics of Understanding Source: Interchange. p.2,4. September 1998. Contact: Rogers Memorial Hospital, 34700 Valley Rd., Oconomowoc, WI 53066-4599. Summary: Holbrook calls for understanding of the eating-disordered patient as a person, not simply as a person with an eating disorder. He says that this understanding of the patient is crucial for the professional working with these patients. Such patients, in his view, do not simply have an eating disorder, but are an eating disorder. Therefore, the clinician must work with the client as a whole person.

·

Management of Laxative Abuse in Eating Disorders Source: SCAN'S PULSE. 18(3): 7-8. Fall 1999. Contact: Available from American Dietetic Association. SCAN Office, 90 S. Cascade Avenue, Suite 1230, Colorado Springs, CO 80903. (719) 4757751. Fax (719) 475-8748. Summary: Health professionals who treat eating disorders eventually encounter clients with anorexia nervosa or bulimia who use laxatives as a method of weight control. This article reviews the management of laxative abuse in patients with eating disorders. Women who abuse laxatives believe that taking laxatives after food consumption prevents the absorption of calories in the intestine. However, studies show that laxative use only decreases caloric absorption by 12 percent, because


laxatives primarily exert their effect in the large intestine. In addition to being ineffective in weight control, chronic laxative use is also medically dangerous. Serious problems that may occur include electrolyte and fluid imbalance leading to metabolic acidosis or alkalosis, permanent structural and functional damage to the colon, interstitial renal (kidney) disease, and rectal prolapse. The successful management of chronic laxative abuse requires a team of professionals that includes a physician, nutrition therapist, and psychotherapist. The author reviews the treatment protocol for these patients, which includes adequate dietary fiber and fluids intake, limited consumption of high sodium and gas forming foods, regular exercise, and patient education. During weekly appointments, the nutrition therapist should evaluate the client's compliance with the prescribed treatment plan. The author cautions that discontinuing long term laxative abuse is extremely difficult, and some clients may require inpatient treatment to be successful. Body image issues become predominant as the client experiences severe fluid retention, often in the range of 10 to 20 pounds, until natural diuresis occurs after about 4 to 6 weeks of laxative abstinence. 9 references. ·

Eating Disorders and Young Women: A Growing Problem Source: Mayo Clinic Health Letter. April 1997. Contact: Mayo Clinic Health Letter, Mayo Foundation for Medical Education, Rochester MN 55905. Web Site: http://www.mayo.edu. Summary: This article discusses the causes and definitions of eating disorders. Two disorders are discussed in detail: anorexia nervosa, in which an individual does not eat enough to maintain a normal weight; and bulimia nervosa, in which an individual eats large amounts of highcalorie food, and then vomits or uses laxatives to purge the food before the body can absorb it. Alexander Lucas, a child and adolescent psychiatrist at the Mayo Clinic, describes the usual pattern of the disorders and their causes. He lists warning signs for family and friends, and says the importance of early treatment.

·

Dieting Not Linked to Eating Disorders in Overweight Adults Source: WIN Notes. pp. 1, 8. Fall 2001. Contact: Weight-control Information Network. 1-877-WIN-4627. Summary: The National Task Force on Prevention and Treatment of Obesity conducted a literature review and concluded that dieting, the intentional and sustained restriction of caloric intake to reduce body weight or change body shape, does not appear to cause eating disorders or other psychological dysfunction in overweight and obese adults.


Reporting in the September 25, 2000, Archives of Internal Medicine, the task force found that weight-loss treatment, very low calorie diets (VLCDs), weight cycling, prescription medications, and 'nondieting' approaches do not support concerns that dieting may lead to or worsen eating disorders in overweight and obese adults. The task force also found that such concerns should not discourage overweight adults from eating fewer calories and being more active to lose a moderate amount of weight or to prevent additional weight gain. ·

Eating Disorders and Borderline Personality Disorder Source: American Anorexia/Bulimia Association Newsletter. p.1-3. Summer 1998. Contact: American Anorexia/Bulimia Association, 165 West 46 Street, Suite 1108, New York, NY 10036. (212) 575- 6200. Summary: Dennis suggests that some eating- disordered patients may be suffering from Borderline Personality Disorder (BPD), as recognized in the American Psychiatric Association's `Diagnostic and Statistical Manual 4th ed.' (DSM-IV). According to Dennis, the behaviors associated with eating disorders serve adaptive functions for an individual with BPD. These include: reinforcement of their feelings of low self-esteem, since they can never be thin enough; allowing them to soothe themselves through food, which they find difficult otherwise; and purging to allow them to feel a sense of self-control. Finally, the behaviors associated with eating disorders are self- destructive and may be used as self-punishment by the BPD patient, and these behaviors may also serve as a numbing agent against the emotional pain they feel. As a result, says Dennis, treatment should be different, more intensive and lengthy.

·

Obsessive Compulsive Disorder and Eating Disorders Source: American Anorexia/Bulimia Association Newsletter. p.4-5. Summer 1998. Contact: American Anorexia/Bulimia Association, 165 West 46 Street, Suite 1108, New York, NY 10036. (212) 575- 6200. Summary: Wall argues that many eating-disordered patients are obsessive-compulsive disordered (OCD), and food is the medium of their obsession-compulsion. He notes that most eating-disordered patients are women, and that women are conditioned by society to worry more about food and their weight than men. Therefore, says Wall, an eating disorder is the form taken by the patient's OCD. He suggests that eating disorders could be treated by many of the same methods used for OCD, such as antidepressant medications and response prevention therapy.


·

Eating Disorders in Children Source: American Anorexia/Bulimia Association, Inc. Newsletter. p.1011. Summer 1997. Contact: American Anorexia/Bulimia Association, 165 West 46 Street, Suite 1108, New York, NY 10036. (212) 575- 6200. Summary: This article examines the effect mothers' eating disorders have on their infants and toddlers. The authors found a link between the mothers' eating disorders and disordered eating in the children. They hypothesize that children internalize their mothers' disordered eating and food habits. The Eating Disorders Therapeutic Nursery, developed by the authors, successfully treated mothers and children as a unit. Sherkow and Lowenthal recommend further research on the link between maternal eating disorders and childhood eating disorders.

·

Eating Disorders in the Family Source: American Anorexia/Bulimia Association, Inc. Newsletter. p.7-8. Summer 1997. Contact: American Anorexia/Bulimia Association, 165 West 46 Street, Suite 1108, New York, NY 10036. (212) 575- 6200. Summary: This article discusses the family's role in the development and treatment of eating disorders. The author briefly discusses the possible genetic basis for a predisposition to develop eating orders, the author offers several suggestions for the involvement of the family in the treatment plan. Greenfield says that whether the eating disorder is a product of disorder family relationships or not, the parents and siblings of the patient must be included in the therapy. Some suggestions include a set plan for therapy, limits on discussion of the eating disorder outside of therapy sessions, control limits set for both parents and patient and attention to the needs of the siblings as well.

Academic Periodicals covering Binge Eating Disorder Academic periodicals can be a highly technical yet valuable source of information on binge eating disorder. We have compiled the following list of periodicals known to publish articles relating to binge eating disorder and which are currently indexed within the National Library of Medicine’s PubMed database (follow hyperlinks to view more information, summaries, etc., for each). In addition to these sources, to keep current on articles written on binge eating disorder published by any of the periodicals listed below,


you can simply follow the hyperlink indicated or go to the following Web site: www.ncbi.nlm.nih.gov/pubmed. Type the periodical’s name into the search box to find the latest studies published. If you want complete details about the historical contents of a periodical, you can also visit http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi. Here, type in the name of the journal or its abbreviation, and you will receive an index of published articles. At http://locatorplus.gov/ you can retrieve more indexing information on medical periodicals (e.g. the name of the publisher). Select the button “Search LOCATORplus.” Then type in the name of the journal and select the advanced search option “Journal Title Search.” The following is a sample of periodicals which publish articles on binge eating disorder: ·

Acta Psychiatrica Scandinavica. (Acta Psychiatr Scand) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Ac ta+Psychiatrica+Scandinavica&dispmax=20&dispstart=0

·

Addictive Behaviors. (Addict Behav) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=A ddictive+Behaviors&dispmax=20&dispstart=0

·

Biological Psychology. (Biol Psychol) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Bi ological+Psychology&dispmax=20&dispstart=0

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Journal of Clinical Psychology. (J Clin Psychol) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Jo urnal+of+Clinical+Psychology&dispmax=20&dispstart=0

·

Psychological Medicine. (Psychol Med) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Ps ychological+Medicine&dispmax=20&dispstart=0

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Psychosomatic Medicine. (Psychosom Med) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Ps ychosomatic+Medicine&dispmax=20&dispstart=0


Vocabulary Builder Alkalosis: A pathologic condition resulting from accumulation of base, or from loss of acid without comparable loss of base in the body fluids, and characterized by decrease in hydrogen ion concentration (increase in pH). [EU]

Chemotherapy: The treatment of disease by means of chemicals that have a specific toxic effect upon the disease - producing microorganisms or that selectively destroy cancerous tissue. [EU] Interstitial: Pertaining to or situated between parts or in the interspaces of a tissue. [EU] Laceration: 1. the act of tearing. 2. a torn, ragged, mangled wound. [EU] Nausea: An unpleasant sensation, vaguely referred to the epigastrium and abdomen, and often culminating in vomiting. [EU] Predisposition: A latent susceptibility to disease which may be activated under certain conditions, as by stress. [EU] Rectal: Pertaining to the rectum (= distal portion of the large intestine). [EU] Vaccination: The introduction of vaccine into the body for the purpose of inducing immunity. Coined originally to apply to the injection of smallpox vaccine, the term has come to mean any immunizing procedure in which vaccine is injected. [EU] Veterinarians: Individuals with a degree in veterinary medicine that provides them with training and qualifications to treat diseases and injuries of animals. [NIH]

Physician Guidelines and Databases 109

CHAPTER 8. PHYSICIAN GUIDELINES AND DATABASES Overview Doctors and medical researchers rely on a number of information sources to help patients with their conditions. Many will subscribe to journals or newsletters published by their professional associations or refer to specialized textbooks or clinical guides published for the medical profession. In this chapter, we focus on databases and Internet-based guidelines created or written for this professional audience.

NIH Guidelines For the more common diseases, The National Institutes of Health publish guidelines that are frequently consulted by physicians. Publications are typically written by one or more of the various NIH Institutes. For physician guidelines, commonly referred to as “clinical” or “professional” guidelines, you can visit the following Institutes: ·

Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm

·

National Institute of General Medical Sciences (NIGMS); fact sheets available at http://www.nigms.nih.gov/news/facts/

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National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines: http://www.nlm.nih.gov/medlineplus/healthtopics.html

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National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); guidelines available at http://www.niddk.nih.gov/health/health.htm


NIH Databases In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.26 Physician-oriented resources provide a wide variety of information related to the biomedical and health sciences, both past and present. The format of these resources varies. Searchable databases, bibliographic citations, full text articles (when available), archival collections, and images are all available. The following are referenced by the National Library of Medicine:27 ·

Bioethics: Access to published literature on the ethical, legal and public policy issues surrounding healthcare and biomedical research. This information is provided in conjunction with the Kennedy Institute of Ethics located at Georgetown University, Washington, D.C.: http://www.nlm.nih.gov/databases/databases_bioethics.html

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HIV/AIDS Resources: Describes various links and databases dedicated to HIV/AIDS research: http://www.nlm.nih.gov/pubs/factsheets/aidsinfs.html

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NLM Online Exhibitions: Describes “Exhibitions in the History of Medicine”: http://www.nlm.nih.gov/exhibition/exhibition.html. Additional resources for historical scholarship in medicine: http://www.nlm.nih.gov/hmd/hmd.html

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Biotechnology Information: Access to public databases. The National Center for Biotechnology Information conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information for the better understanding of molecular processes affecting human health and disease: http://www.ncbi.nlm.nih.gov/

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Population Information: The National Library of Medicine provides access to worldwide coverage of population, family planning, and related health issues, including family planning technology and programs, fertility, and population law and policy: http://www.nlm.nih.gov/databases/databases_population.html

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Cancer Information: Access to caner-oriented databases: http://www.nlm.nih.gov/databases/databases_cancer.html

Remember, for the general public, the National Library of Medicine recommends the databases referenced in MEDLINEplus (http://medlineplus.gov/ or http://www.nlm.nih.gov/medlineplus/databases.html). 27 See http://www.nlm.nih.gov/databases/databases.html. 26


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Profiles in Science: Offering the archival collections of prominent twentieth-century biomedical scientists to the public through modern digital technology: http://www.profiles.nlm.nih.gov/

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Chemical Information: Provides links to various chemical databases and references: http://sis.nlm.nih.gov/Chem/ChemMain.html

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Clinical Alerts: Reports the release of findings from the NIH-funded clinical trials where such release could significantly affect morbidity and mortality: http://www.nlm.nih.gov/databases/alerts/clinical_alerts.html

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Space Life Sciences: Provides links and information to space-based research (including NASA): http://www.nlm.nih.gov/databases/databases_space.html

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MEDLINE: Bibliographic database covering the fields of medicine, nursing, dentistry, veterinary medicine, the healthcare system, and the pre-clinical sciences: http://www.nlm.nih.gov/databases/databases_medline.html

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Toxicology and Environmental Health Information (TOXNET): Databases covering toxicology and environmental health: http://sis.nlm.nih.gov/Tox/ToxMain.html

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Visible Human Interface: Anatomically detailed, three-dimensional representations of normal male and female human bodies: http://www.nlm.nih.gov/research/visible/visible_human.html

While all of the above references may be of interest to physicians who study and treat binge eating disorder, the following are particularly noteworthy.

The Combined Health Information Database A comprehensive source of information on clinical guidelines written for professionals is the Combined Health Information Database. You will need to limit your search to “Brochure/Pamphlet,” “Fact Sheet,” or “Information Package” and binge eating disorder using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For the publication date, select “All Years,” select your preferred language, and the format option “Fact Sheet.” By making these selections and typing “binge eating disorder” (or synonyms) into the “For these words:” box above, you will only receive results on fact sheets dealing with binge eating disorder. The following is a sample result:


·

[Anorexia Nervosa and Associated Disorders Information Packet] Source: Highland Park, IL: National Association of Anorexia Nervosa and Associated Disorders, Inc. (ANAD). [13 p.]. Contact: Available from National Association of Anorexia Nervosa and Associated Disorders, Inc. (ANAD). Box 7, Highland Park, IL 60035. (708) 831-3438; Fax (708) 433-4632. Price: Free. Summary: This information packet about anorexia nervosa, bulimia, and related disorders contains fact sheets with descriptions of eating disorders, typical symptoms, treatment approaches, suggestions for self help, suggestions for finding a therapist and remaining in therapy, physical problems caused by eating disorders, reasons to intensify and expand eating disorders prevention and education programs, and services and resources of the National Association of Anorexia Nervosa and Associated Disorders (ANAD). An ANAD bibliography is included.

·

Straight Talk: Self - Esteem Source: Rodale's Straight Talk: A Magazine for Teens 1991;1(2):1-25. Contact: Learning Partnership, PO Box 199, Pleasantville, NY, 10570, (914) 769-0055. Summary: Straight Talk is a series of publications in contemporary-teenmagazine format that addresses critical health and behavioral issues confronting today's adolescents and serves as a resource for riskreduction and prevention programs for youth aged 12 to 15 in a variety of settings. The series is organized around a central concept of enhancing individual self-esteem. Each title focuses on a specific topical area: the human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) and other sexually transmitted diseases (STDs), selfesteem, substance abuse, and teen relationships and choices. This prevention program helps professionals foster and enhance critical thinking skills, refusal skills, decision-making skills, communications and persuasion skills, coping skills, conflict-resolution skills, and acceptance of responsibility for self and others. The Self-Esteem module provides articles and illustrative materials combined to provide important facts, challenge and explore attitudes, enhance skills development, and model healthy behaviors and lifestyles. Firsthand accounts from young people are included. Articles explore the fluctuation of self-esteem; self-esteem and drug abuse, eating disorders, and physical abuse; delinquency; parent-child relations and conflict resolution; parental divorce; decision making; and interracial relationships. A Discussion Leader's Guide, which contains suggested discussion questions, individual and small


group activities, duplicating masters, and a set of family/home involvement activities, is available.

The NLM Gateway28 The NLM (National Library of Medicine) Gateway is a Web-based system that lets users search simultaneously in multiple retrieval systems at the U.S. National Library of Medicine (NLM). It allows users of NLM services to initiate searches from one Web interface, providing “one-stop searching” for many of NLM’s information resources or databases.29 One target audience for the Gateway is the Internet user who is new to NLM’s online resources and does not know what information is available or how best to search for it. This audience may include physicians and other healthcare providers, researchers, librarians, students, and, increasingly, patients, their families, and the public.30 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “binge eating disorder” (or synonyms) into the search box and click “Search.” The results will be presented in a tabular form, indicating the number of references in each database category. Results Summary Category Items Found Journal Articles 516 Books / Periodicals / Audio Visual 6 Consumer Health 16 Meeting Abstracts 1 Other Collections 0 Total 539

Adapted from NLM: http://gateway.nlm.nih.gov/gw/Cmd?Overview.x. The NLM Gateway is currently being developed by the Lister Hill National Center for Biomedical Communications (LHNCBC) at the National Library of Medicine (NLM) of the National Institutes of Health (NIH). 30 Other users may find the Gateway useful for an overall search of NLM’s information resources. Some searchers may locate what they need immediately, while others will utilize the Gateway as an adjunct tool to other NLM search services such as PubMed® and MEDLINEplus®. The Gateway connects users with multiple NLM retrieval systems while also providing a search interface for its own collections. These collections include various types of information that do not logically belong in PubMed, LOCATORplus, or other established NLM retrieval systems (e.g., meeting announcements and pre-1966 journal citations). The Gateway will provide access to the information found in an increasing number of NLM retrieval systems in several phases. 28 29


HSTAT31 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.32 HSTAT’s audience includes healthcare providers, health service researchers, policy makers, insurance companies, consumers, and the information professionals who serve these groups. HSTAT provides access to a wide variety of publications, including clinical practice guidelines, quick-reference guides for clinicians, consumer health brochures, evidence reports and technology assessments from the Agency for Healthcare Research and Quality (AHRQ), as well as AHRQ’s Put Prevention Into Practice.33 Simply search by “binge eating disorder” (or synonyms) at the following Web site: http://text.nlm.nih.gov.

Coffee Break: Tutorials for Biologists34 Some patients may wish to have access to a general healthcare site that takes a scientific view of the news and covers recent breakthroughs in biology that may one day assist physicians in developing treatments. To this end, we recommend “Coffee Break,” a collection of short reports on recent biological discoveries. Each report incorporates interactive tutorials that demonstrate how bioinformatics tools are used as a part of the research process. Currently, all Coffee Breaks are written by NCBI staff.35 Each report is about 400 words and is usually based on a discovery reported in one or more articles from recently published, peer-reviewed literature.36 This site has new Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html. The HSTAT URL is http://hstat.nlm.nih.gov/. 33 Other important documents in HSTAT include: the National Institutes of Health (NIH) Consensus Conference Reports and Technology Assessment Reports; the HIV/AIDS Treatment Information Service (ATIS) resource documents; the Substance Abuse and Mental Health Services Administration’s Center for Substance Abuse Treatment (SAMHSA/CSAT) Treatment Improvement Protocols (TIP) and Center for Substance Abuse Prevention (SAMHSA/CSAP) Prevention Enhancement Protocols System (PEPS); the Public Health Service (PHS) Preventive Services Task Force’s Guide to Clinical Preventive Services; the independent, nonfederal Task Force on Community Services Guide to Community Preventive Services; and the Health Technology Advisory Committee (HTAC) of the Minnesota Health Care Commission (MHCC) health technology evaluations. 34 Adapted from http://www.ncbi.nlm.nih.gov/Coffeebreak/Archive/FAQ.html. 35 The figure that accompanies each article is frequently supplied by an expert external to NCBI, in which case the source of the figure is cited. The result is an interactive tutorial that tells a biological story. 36 After a brief introduction that sets the work described into a broader context, the report focuses on how a molecular understanding can provide explanations of observed biology and lead to therapies for diseases. Each vignette is accompanied by a figure and hypertext links that lead to a series of pages that interactively show how NCBI tools and resources are used in the research process. 31 32


articles every few weeks, so it can be considered an online magazine of sorts, and intended for general background information. You can access the Coffee Break Web site at http://www.ncbi.nlm.nih.gov/Coffeebreak/.

Other Commercial Databases In addition to resources maintained by official agencies, other databases exist that are commercial ventures addressing medical professionals. Here are a few examples that may interest you: ·

CliniWeb International: Index and table of contents to selected clinical information on the Internet; see http://www.ohsu.edu/cliniweb/.

·

Image Engine: Multimedia electronic medical record system that integrates a wide range of digitized clinical images with textual data stored in the University of Pittsburgh Medical Center’s MARS electronic medical record system; see the following Web site: http://www.cml.upmc.edu/cml/imageengine/imageEngine.html.

·

Medical World Search: Searches full text from thousands of selected medical sites on the Internet; see http://www.mwsearch.com/.

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MedWeaver: Prototype system that allows users to search differential diagnoses for any list of signs and symptoms, to search medical literature, and to explore relevant Web sites; see http://www.med.virginia.edu/~wmd4n/medweaver.html.

·

Metaphrase: Middleware component intended for use by both caregivers and medical records personnel. It converts the informal language generally used by caregivers into terms from formal, controlled vocabularies; see the following Web site: http://www.lexical.com/Metaphrase.html.

Specialized References The following books are specialized references written for professionals interested in binge eating disorder (sorted alphabetically by title, hyperlinks provide rankings, information, and reviews at Amazon.com): · Evaluation & Management of Obesity by Daniel H. Bessesen, Robert F. Kushner; Paperback, 1st edition (December 15, 2001), Lippincott Williams & Wilkins Publishers; ISBN: 1560534699; http://www.amazon.com/exec/obidos/ASIN/1560534699/icongroupinterna


· Handbook of Obesity Treatment by Thomas A. Wadden (Editor), Albert J. Stunkard (Editor); Hardcover: 624 pages, 3rd edition (January 9, 2002), Guilford Press; ISBN: 1572307226; http://www.amazon.com/exec/obidos/ASIN/1572307226/icongroupinterna · Inborn Metabolic Diseases : Diagnosis and Treatment by J. Fernandes (Editor), et al; Hardcover, 3rd edition (August 2000), Springer Verlag; ISBN: 354065626X; http://www.amazon.com/exec/obidos/ASIN/354065626X/icongroupinterna

· Overweight and Weight Management: the Health Professional’s Guide to Understanding and Treatment by Sharron Dalton; Hardcover: 615 pages, 1st edition (January 15, 1997), Aspen Publishers, Inc.; ISBN: 0834206366; http://www.amazon.com/exec/obidos/ASIN/0834206366/icongroupinterna

Dissertations 117

CHAPTER 9. DISSERTATIONS ON BINGE EATING DISORDER Overview University researchers are active in studying almost all known diseases. The result of research is often published in the form of Doctoral or Master’s dissertations. You should understand, therefore, that applied diagnostic procedures and/or therapies can take many years to develop after the thesis that proposed the new technique or approach was written. In this chapter, we will give you a bibliography on recent dissertations relating to binge eating disorder. You can read about these in more detail using the Internet or your local medical library. We will also provide you with information on how to use the Internet to stay current on dissertations.

Dissertations on Binge Eating Disorder ProQuest Digital Dissertations is the largest archive of academic dissertations available. From this archive, we have compiled the following list covering dissertations devoted to binge eating disorder. You will see that the information provided includes the dissertation’s title, its author, and the author’s institution. To read more about the following, simply use the Internet address indicated. The following covers recent dissertations dealing with binge eating disorder: ·

A Controlled Trial of Cognitive-behavioral Therapy with and without Spousal Involvement for Binge Eating Disorder by Gorin, Amy A.; Phd from State University of New York at Stony Brook, 2000, 127 pages http://wwwlib.umi.com/dissertations/fullcit/9989005


·

Differentiating Anorexia Nervosa, Bulimia Nervosa, and Binge Eating Disorder Using the Pai and Edi-2 by Demidenko, Natalie; Ma from Carleton University (canada), 2000, 93 pages http://wwwlib.umi.com/dissertations/fullcit/MQ48422

·

Factors Affecting Drop-out and Length of Treatment in Binge Eating Disorder by Blackman, Lisa R.; Phd from Northwestern University, 2000, 54 pages http://wwwlib.umi.com/dissertations/fullcit/9974250

·

Negative Affect among Patients with Binge Eating Disorder: Impact at Baseline and Following Treatment by Dounchis, Jennifer Zoler; Phd from University of California, San Diego, 2001, 80 pages http://wwwlib.umi.com/dissertations/fullcit/3007132

·

One Size Does Not Fit All: an Analysis of Contemporary Treatments for Binge Eating Disorder by Ferrell, Holley Elizabeth; Psyd from California School of Professional Psychology - Berkeley/alameda, 2001, 142 pages http://wwwlib.umi.com/dissertations/fullcit/3009220

·

Risk Factors for the Development of Bulimia Nervosa and Binge Eating Disorder: What Are the Differences? by Sullivan, Keri Ann; Msc from University of Calgary (canada), 2000, 252 pages http://wwwlib.umi.com/dissertations/fullcit/MQ55244

·

The Effects of Binge Eating Disorder and Weight on the Eating Disorder Inventory - 2: an Exploratory Study by Jackson, Cara Lee, Phd from State University of New York at Buffalo, 1996, 90 pages http://wwwlib.umi.com/dissertations/fullcit/9704890

·

The Influence of Womanist Identity on the Development of Eating Disorders and Depression in African American Female College Students by Ford, Theresa; Phd from The College of William and Mary, 2000, 161 pages http://wwwlib.umi.com/dissertations/fullcit/9974940

Dissertations 119

Keeping Current As previously mentioned, an effective way to stay current on dissertations dedicated to binge eating disorder is to use the database called ProQuest Digital Dissertations via the Internet, located at the following Web address: http://wwwlib.umi.com/dissertations. The site allows you to freely access the last two years of citations and abstracts. Ask your medical librarian if the library has full and unlimited access to this database. From the library, you should be able to do more complete searches than with the limited 2-year access available to the general public.

121

PART III. APPENDICES

ABOUT PART III Part III is a collection of appendices on general medical topics which may be of interest to patients with binge eating disorder and related conditions.

Researching Your Medications 123

APPENDIX A. RESEARCHING YOUR MEDICATIONS Overview There are a number of sources available on new or existing medications which could be prescribed to patients with binge eating disorder. While a number of hard copy or CD-Rom resources are available to patients and physicians for research purposes, a more flexible method is to use Internetbased databases. In this chapter, we will begin with a general overview of medications. We will then proceed to outline official recommendations on how you should view your medications. You may also want to research medications that you are currently taking for other conditions as they may interact with medications for binge eating disorder. Research can give you information on the side effects, interactions, and limitations of prescription drugs used in the treatment of binge eating disorder. Broadly speaking, there are two sources of information on approved medications: public sources and private sources. We will emphasize free-to-use public sources.


Your Medications: The Basics37 The Agency for Health Care Research and Quality has published extremely useful guidelines on how you can best participate in the medication aspects of binge eating disorder. Taking medicines is not always as simple as swallowing a pill. It can involve many steps and decisions each day. The AHCRQ recommends that patients with binge eating disorder take part in treatment decisions. Do not be afraid to ask questions and talk about your concerns. By taking a moment to ask questions early, you may avoid problems later. Here are some points to cover each time a new medicine is prescribed: ·

Ask about all parts of your treatment, including diet changes, exercise, and medicines.

·

Ask about the risks and benefits of each medicine or other treatment you might receive.

·

Ask how often you or your doctor will check for side effects from a given medication.

Do not hesitate to ask what is important to you about your medicines. You may want a medicine with the fewest side effects, or the fewest doses to take each day. You may care most about cost, or how the medicine might affect how you live or work. Or, you may want the medicine your doctor believes will work the best. Telling your doctor will help him or her select the best treatment for you. Do not be afraid to “bother” your doctor with your concerns and questions about medications for binge eating disorder. You can also talk to a nurse or a pharmacist. They can help you better understand your treatment plan. Feel free to bring a friend or family member with you when you visit your doctor. Talking over your options with someone you trust can help you make better choices, especially if you are not feeling well. Specifically, ask your doctor the following: ·

The name of the medicine and what it is supposed to do.

·

How and when to take the medicine, how much to take, and for how long.

·

What food, drinks, other medicines, or activities you should avoid while taking the medicine.

·

What side effects the medicine may have, and what to do if they occur.

37

This section is adapted from AHCRQ: http://www.ahcpr.gov/consumer/ncpiebro.htm.


·

If you can get a refill, and how often.

·

About any terms or directions you do not understand.

·

What to do if you miss a dose.

·

If there is written information you can take home (most pharmacies have information sheets on your prescription medicines; some even offer large-print or Spanish versions).

Do not forget to tell your doctor about all the medicines you are currently taking (not just those for binge eating disorder). This includes prescription medicines and the medicines that you buy over the counter. Then your doctor can avoid giving you a new medicine that may not work well with the medications you take now. When talking to your doctor, you may wish to prepare a list of medicines you currently take, the reason you take them, and how you take them. Be sure to include the following information for each: ·

Name of medicine

·

Reason taken

·

Dosage

·

Time(s) of day

Also include any over-the-counter medicines, such as: ·

Laxatives

·

Diet pills

·

Vitamins

·

Cold medicine

·

Aspirin or other pain, headache, or fever medicine

·

Cough medicine

·

Allergy relief medicine

·

Antacids

·

Sleeping pills

·

Others (include names)


Learning More about Your Medications Because of historical investments by various organizations and the emergence of the Internet, it has become rather simple to learn about the medications your doctor has recommended for binge eating disorder. One such source is the United States Pharmacopeia. In 1820, eleven physicians met in Washington, D.C. to establish the first compendium of standard drugs for the United States. They called this compendium the “U.S. Pharmacopeia (USP).” Today, the USP is a non-profit organization consisting of 800 volunteer scientists, eleven elected officials, and 400 representatives of state associations and colleges of medicine and pharmacy. The USP is located in Rockville, Maryland, and its home page is located at www.usp.org. The USP currently provides standards for over 3,700 medications. The resulting USP DIÒ Advice for the PatientÒ can be accessed through the National Library of Medicine of the National Institutes of Health. The database is partially derived from lists of federally approved medications in the Food and Drug Administration’s (FDA) Drug Approvals database.38 While the FDA database is rather large and difficult to navigate, the Phamacopeia is both user-friendly and free to use. It covers more than 9,000 prescription and over-the-counter medications. To access this database, simply type the following hyperlink into your Web browser: http://www.nlm.nih.gov/medlineplus/druginformation.html. To view examples of a given medication (brand names, category, description, preparation, proper use, precautions, side effects, etc.), simply follow the hyperlinks indicated within the United States Pharmacopoeia. It is important to read the disclaimer by the United States Pharmacopoeia (http://www.nlm.nih.gov/medlineplus/drugdisclaimer.html) before using the information provided. Of course, we as editors cannot be certain as to what medications you are taking. Therefore, we have compiled a list of medications associated with the treatment of binge eating disorder. Once again, due to space limitations, we only list a sample of medications and provide hyperlinks to ample documentation (e.g. typical dosage, side effects, drug-interaction risks, etc.). The following drugs have been mentioned in the Pharmacopeia and other sources as being potentially applicable to binge eating disorder:

Though cumbersome, the FDA database can be freely browsed at the following site: www.fda.gov/cder/da/da.htm. 38


Fluoxetine ·

Systemic - U.S. Brands: Prozac; Sarafem http://www.nlm.nih.gov/medlineplus/druginfo/fluoxetinesyste mic202247.html

Zinc Supplements ·

Systemic - U.S. Brands: Orazinc; Verazinc; Zinc 15; Zinc-220; Zinca-Pak; Zincate http://www.nlm.nih.gov/medlineplus/druginfo/zincsupplement ssystemic202622.html

Commercial Databases In addition to the medications listed in the USP above, a number of commercial sites are available by subscription to physicians and their institutions. You may be able to access these sources from your local medical library or your doctor’s office.

Reuters Health Drug Database The Reuters Health Drug Database can be searched by keyword at the hyperlink: http://www.reutershealth.com/frame2/drug.html. The following medications are listed in the Reuters’ database as associated with binge eating disorder (including those with contraindications):39 ·

Amitriptyline HCl http://www.reutershealth.com/atoz/html/Amitriptyline_HCl.htm

·

Desipramine HCl http://www.reutershealth.com/atoz/html/Desipramine_HCl.htm

·

Fluoxetine HCl http://www.reutershealth.com/atoz/html/Fluoxetine_HCl.htm

·

Imipramine HCl http://www.reutershealth.com/atoz/html/Imipramine_HCl.htm

·

Ondansetron HCl http://www.reutershealth.com/atoz/html/Ondansetron_HCl.htm

39

Adapted from A to Z Drug Facts by Facts and Comparisons.


Mosby’s GenRx Mosby’s GenRx database (also available on CD-Rom and book format) covers 45,000 drug products including generics and international brands. It provides prescribing information, drug interactions, and patient information. Information in Mosby’s GenRx database can be obtained at the following hyperlink: http://www.genrx.com/Mosby/PhyGenRx/group.html.

Physicians Desk Reference The Physicians Desk Reference database (also available in CD-Rom and book format) is a full-text drug database. The database is searchable by brand name, generic name or by indication. It features multiple drug interactions reports. Information can be obtained at the following hyperlink: http://physician.pdr.net/physician/templates/en/acl/psuser_t.htm. Other Web Sites A number of additional Web sites discuss drug information. As an example, you may like to look at www.drugs.com which reproduces the information in the Pharmacopeia as well as commercial information. You may also want to consider the Web site of the Medical Letter, Inc. which allows users to download articles on various drugs and therapeutics for a nominal fee: http://www.medletter.com/.

Contraindications and Interactions (Hidden Dangers) Some of the medications mentioned in the previous discussions can be problematic for patients with binge eating disorder--not because they are used in the treatment process, but because of contraindications, or side effects. Medications with contraindications are those that could react with drugs used to treat binge eating disorder or potentially create deleterious side effects in patients with binge eating disorder. You should ask your physician about any contraindications, especially as these might apply to other medications that you may be taking for common ailments. Drug-drug interactions occur when two or more drugs react with each other. This drug-drug interaction may cause you to experience an unexpected side effect. Drug interactions may make your medications less effective, cause


unexpected side effects, or increase the action of a particular drug. Some drug interactions can even be harmful to you. Be sure to read the label every time you use a nonprescription or prescription drug, and take the time to learn about drug interactions. These precautions may be critical to your health. You can reduce the risk of potentially harmful drug interactions and side effects with a little bit of knowledge and common sense. Drug labels contain important information about ingredients, uses, warnings, and directions which you should take the time to read and understand. Labels also include warnings about possible drug interactions. Further, drug labels may change as new information becomes available. This is why it’s especially important to read the label every time you use a medication. When your doctor prescribes a new drug, discuss all over-thecounter and prescription medications, dietary supplements, vitamins, botanicals, minerals and herbals you take as well as the foods you eat. Ask your pharmacist for the package insert for each prescription drug you take. The package insert provides more information about potential drug interactions.

A Final Warning At some point, you may hear of alternative medications from friends, relatives, or in the news media. Advertisements may suggest that certain alternative drugs can produce positive results for patients with binge eating disorder. Exercise caution--some of these drugs may have fraudulent claims, and others may actually hurt you. The Food and Drug Administration (FDA) is the official U.S. agency charged with discovering which medications are likely to improve the health of patients with binge eating disorder. The FDA warns patients to watch out for40: ·

Secret formulas (real scientists share what they know)

·

Amazing breakthroughs or miracle cures (real breakthroughs don’t happen very often; when they do, real scientists do not call them amazing or miracles)

·

Quick, painless, or guaranteed cures

·

If it sounds too good to be true, it probably isn’t true.

40

This section has been adapted from http://www.fda.gov/opacom/lowlit/medfraud.html.


If you have any questions about any kind of medical treatment, the FDA may have an office near you. Look for their number in the blue pages of the phone book. You can also contact the FDA through its toll-free number, 1888-INFO-FDA (1-888-463-6332), or on the World Wide Web at www.fda.gov.

General References In addition to the resources provided earlier in this chapter, the following general references describe medications (sorted alphabetically by title; hyperlinks provide rankings, information and reviews at Amazon.com): ·

Complete Guide to Prescription and Nonprescription Drugs 2001 (Complete Guide to Prescription and Nonprescription Drugs, 2001) by H. Winter Griffith, Paperback 16th edition (2001), Medical Surveillance; ISBN: 0942447417; http://www.amazon.com/exec/obidos/ASIN/039952634X/icongroupinterna

·

The Essential Guide to Prescription Drugs, 2001 by James J. Rybacki, James W. Long; Paperback - 1274 pages (2001), Harper Resource; ISBN: 0060958162; http://www.amazon.com/exec/obidos/ASIN/0060958162/icongroupinterna

·

Handbook of Commonly Prescribed Drugs by G. John Digregorio, Edward J. Barbieri; Paperback 16th edition (2001), Medical Surveillance; ISBN: 0942447417; http://www.amazon.com/exec/obidos/ASIN/0942447417/icongroupinterna

·

Johns Hopkins Complete Home Encyclopedia of Drugs 2nd ed. by Simeon Margolis (Ed.), Johns Hopkins; Hardcover - 835 pages (2000), Rebus; ISBN: 0929661583; http://www.amazon.com/exec/obidos/ASIN/0929661583/icongroupinterna

·

Medical Pocket Reference: Drugs 2002 by Springhouse Paperback 1st edition (2001), Lippincott Williams & Wilkins Publishers; ISBN: 1582550964; http://www.amazon.com/exec/obidos/ASIN/1582550964/icongroupinterna

·

PDR by Medical Economics Staff, Medical Economics Staff Hardcover 3506 pages 55th edition (2000), Medical Economics Company; ISBN: 1563633752; http://www.amazon.com/exec/obidos/ASIN/1563633752/icongroupinterna

·

Pharmacy Simplified: A Glossary of Terms by James Grogan; Paperback 432 pages, 1st edition (2001), Delmar Publishers; ISBN: 0766828581; http://www.amazon.com/exec/obidos/ASIN/0766828581/icongroupinterna


·

Physician Federal Desk Reference by Christine B. Fraizer; Paperback 2nd edition (2001), Medicode Inc; ISBN: 1563373971; http://www.amazon.com/exec/obidos/ASIN/1563373971/icongroupinterna

·

Physician’s Desk Reference Supplements Paperback - 300 pages, 53 edition (1999), ISBN: 1563632950; http://www.amazon.com/exec/obidos/ASIN/1563632950/icongroupinterna

Researching Alternative Medicine 133

APPENDIX B. RESEARCHING ALTERNATIVE MEDICINE Overview Complementary and alternative medicine (CAM) is one of the most contentious aspects of modern medical practice. You may have heard of these treatments on the radio or on television. Maybe you have seen articles written about these treatments in magazines, newspapers, or books. Perhaps your friends or doctor have mentioned alternatives. In this chapter, we will begin by giving you a broad perspective on complementary and alternative therapies. Next, we will introduce you to official information sources on CAM relating to binge eating disorder. Finally, at the conclusion of this chapter, we will provide a list of readings on binge eating disorder from various authors. We will begin, however, with the National Center for Complementary and Alternative Medicine’s (NCCAM) overview of complementary and alternative medicine.

What Is CAM?41 Complementary and alternative medicine (CAM) covers a broad range of healing philosophies, approaches, and therapies. Generally, it is defined as those treatments and healthcare practices which are not taught in medical schools, used in hospitals, or reimbursed by medical insurance companies. Many CAM therapies are termed “holistic,” which generally means that the healthcare practitioner considers the whole person, including physical, mental, emotional, and spiritual health. Some of these therapies are also known as “preventive,” which means that the practitioner educates and 41

Adapted from the NCCAM: http://nccam.nih.gov/nccam/fcp/faq/index.html#what-is.


treats the person to prevent health problems from arising, rather than treating symptoms after problems have occurred. People use CAM treatments and therapies in a variety of ways. Therapies are used alone (often referred to as alternative), in combination with other alternative therapies, or in addition to conventional treatment (sometimes referred to as complementary). Complementary and alternative medicine, or “integrative medicine,” includes a broad range of healing philosophies, approaches, and therapies. Some approaches are consistent with physiological principles of Western medicine, while others constitute healing systems with non-Western origins. While some therapies are far outside the realm of accepted Western medical theory and practice, others are becoming established in mainstream medicine. Complementary and alternative therapies are used in an effort to prevent illness, reduce stress, prevent or reduce side effects and symptoms, or control or cure disease. Some commonly used methods of complementary or alternative therapy include mind/body control interventions such as visualization and relaxation, manual healing including acupressure and massage, homeopathy, vitamins or herbal products, and acupuncture.

What Are the Domains of Alternative Medicine?42 The list of CAM practices changes continually. The reason being is that these new practices and therapies are often proved to be safe and effective, and therefore become generally accepted as “mainstream” healthcare practices. Today, CAM practices may be grouped within five major domains: (1) alternative medical systems, (2) mind-body interventions, (3) biologicallybased treatments, (4) manipulative and body-based methods, and (5) energy therapies. The individual systems and treatments comprising these categories are too numerous to list in this sourcebook. Thus, only limited examples are provided within each. Alternative Medical Systems Alternative medical systems involve complete systems of theory and practice that have evolved independent of, and often prior to, conventional biomedical approaches. Many are traditional systems of medicine that are

42

Adapted from the NCCAM: http://nccam.nih.gov/nccam/fcp/classify/index.html.


practiced by individual cultures throughout the world, including a number of venerable Asian approaches. Traditional oriental medicine emphasizes the balance or disturbances of qi (pronounced chi) or vital energy in health and disease, respectively. Traditional oriental medicine consists of a group of techniques and methods including acupuncture, herbal medicine, oriental massage, and qi gong (a form of energy therapy). Acupuncture involves stimulating specific anatomic points in the body for therapeutic purposes, usually by puncturing the skin with a thin needle. Ayurveda is India’s traditional system of medicine. Ayurvedic medicine (meaning “science of life”) is a comprehensive system of medicine that places equal emphasis on body, mind, and spirit. Ayurveda strives to restore the innate harmony of the individual. Some of the primary Ayurvedic treatments include diet, exercise, meditation, herbs, massage, exposure to sunlight, and controlled breathing. Other traditional healing systems have been developed by the world’s indigenous populations. These populations include Native American, Aboriginal, African, Middle Eastern, Tibetan, and Central and South American cultures. Homeopathy and naturopathy are also examples of complete alternative medicine systems. Homeopathic medicine is an unconventional Western system that is based on the principle that “like cures like,” i.e., that the same substance that in large doses produces the symptoms of an illness, in very minute doses cures it. Homeopathic health practitioners believe that the more dilute the remedy, the greater its potency. Therefore, they use small doses of specially prepared plant extracts and minerals to stimulate the body’s defense mechanisms and healing processes in order to treat illness. Naturopathic medicine is based on the theory that disease is a manifestation of alterations in the processes by which the body naturally heals itself and emphasizes health restoration rather than disease treatment. Naturopathic physicians employ an array of healing practices, including the following: diet and clinical nutrition, homeopathy, acupuncture, herbal medicine, hydrotherapy (the use of water in a range of temperatures and methods of applications), spinal and soft-tissue manipulation, physical therapies (such as those involving electrical currents, ultrasound, and light), therapeutic counseling, and pharmacology.


Mind-Body Interventions Mind-body interventions employ a variety of techniques designed to facilitate the mind’s capacity to affect bodily function and symptoms. Only a select group of mind-body interventions having well-documented theoretical foundations are considered CAM. For example, patient education and cognitive-behavioral approaches are now considered “mainstream.” On the other hand, complementary and alternative medicine includes meditation, certain uses of hypnosis, dance, music, and art therapy, as well as prayer and mental healing.

Biological-Based Therapies This category of CAM includes natural and biological-based practices, interventions, and products, many of which overlap with conventional medicine’s use of dietary supplements. This category includes herbal, special dietary, orthomolecular, and individual biological therapies. Herbal therapy employs an individual herb or a mixture of herbs for healing purposes. An herb is a plant or plant part that produces and contains chemical substances that act upon the body. Special diet therapies, such as those proposed by Drs. Atkins, Ornish, Pritikin, and Weil, are believed to prevent and/or control illness as well as promote health. Orthomolecular therapies aim to treat disease with varying concentrations of chemicals such as magnesium, melatonin, and mega-doses of vitamins. Biological therapies include, for example, the use of laetrile and shark cartilage to treat cancer and the use of bee pollen to treat autoimmune and inflammatory diseases.

Manipulative and Body-Based Methods This category includes methods that are based on manipulation and/or movement of the body. For example, chiropractors focus on the relationship between structure and function, primarily pertaining to the spine, and how that relationship affects the preservation and restoration of health. Chiropractors use manipulative therapy as an integral treatment tool. In contrast, osteopaths place particular emphasis on the musculoskeletal system and practice osteopathic manipulation. Osteopaths believe that all of the body’s systems work together and that disturbances in one system may have an impact upon function elsewhere in the body. Massage therapists manipulate the soft tissues of the body to normalize those tissues.


Energy Therapies Energy therapies focus on energy fields originating within the body (biofields) or those from other sources (electromagnetic fields). Biofield therapies are intended to affect energy fields (the existence of which is not yet experimentally proven) that surround and penetrate the human body. Some forms of energy therapy manipulate biofields by applying pressure and/or manipulating the body by placing the hands in or through these fields. Examples include Qi gong, Reiki and Therapeutic Touch. Qi gong is a component of traditional oriental medicine that combines movement, meditation, and regulation of breathing to enhance the flow of vital energy (qi) in the body, improve blood circulation, and enhance immune function. Reiki, the Japanese word representing Universal Life Energy, is based on the belief that, by channeling spiritual energy through the practitioner, the spirit is healed and, in turn, heals the physical body. Therapeutic Touch is derived from the ancient technique of “laying-on of hands.” It is based on the premises that the therapist’s healing force affects the patient’s recovery and that healing is promoted when the body’s energies are in balance. By passing their hands over the patient, these healers identify energy imbalances. Bioelectromagnetic-based therapies involve the unconventional use of electromagnetic fields to treat illnesses or manage pain. These therapies are often used to treat asthma, cancer, and migraine headaches. Types of electromagnetic fields which are manipulated in these therapies include pulsed fields, magnetic fields, and alternating current or direct current fields.

Can Alternatives Affect My Treatment? A critical issue in pursuing complementary alternatives mentioned thus far is the risk that these might have undesirable interactions with your medical treatment. It becomes all the more important to speak with your doctor who can offer advice on the use of alternatives. Official sources confirm this view. Though written for women, we find that the National Women’s Health Information Center’s advice on pursuing alternative medicine is appropriate for patients of both genders and all ages.43

43

Adapted from http://www.4woman.gov/faq/alternative.htm.


Is It Okay to Want Both Traditional and Alternative Medicine? Should you wish to explore non-traditional types of treatment, be sure to discuss all issues concerning treatments and therapies with your healthcare provider, whether a physician or practitioner of complementary and alternative medicine. Competent healthcare management requires knowledge of both conventional and alternative therapies you are taking for the practitioner to have a complete picture of your treatment plan. The decision to use complementary and alternative treatments is an important one. Consider before selecting an alternative therapy, the safety and effectiveness of the therapy or treatment, the expertise and qualifications of the healthcare practitioner, and the quality of delivery. These topics should be considered when selecting any practitioner or therapy.

Finding CAM References on Binge Eating Disorder Having read the previous discussion, you may be wondering which complementary or alternative treatments might be appropriate for binge eating disorder. For the remainder of this chapter, we will direct you to a number of official sources which can assist you in researching studies and publications. Some of these articles are rather technical, so some patience may be required. National Center for Complementary and Alternative Medicine The National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health (http://nccam.nih.gov) has created a link to the National Library of Medicine’s databases to allow patients to search for articles that specifically relate to binge eating disorder and complementary medicine. To search the database, go to the following Web site: www.nlm.nih.gov/nccam/camonpubmed.html. Select “CAM on PubMed.” Enter “binge eating disorder” (or synonyms) into the search box. Click “Go.” The following references provide information on particular aspects of complementary and alternative medicine (CAM) that are related to binge eating disorder: ·

"Recovered memory" therapy for eating disorders: implications of the Ramona verdict. Author(s): Pope HG Jr, Hudson JI.


Source: The International Journal of Eating Disorders. 1996 March; 19(2): 139-45. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8932552&dopt=Abstract ·

"Spiritual starvation?": a case series concerning christianity and eating disorders. Author(s): Morgan JF, Marsden P, Lacey JH. Source: The International Journal of Eating Disorders. 2000 December; 28(4): 476-80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11054798&dopt=Abstract

·

A comparison of nutritional management with stress management in the treatment of bulimia nervosa. Author(s): Laessle RG, Beumont PJ, Butow P, Lennerts W, O'Connor M, Pirke KM, Touyz SW, Waadt S. Source: The British Journal of Psychiatry; the Journal of Mental Science. 1991 August; 159: 250-61. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1773242&dopt=Abstract

·

A randomized controlled trial of guided imagery in bulimia nervosa. Author(s): Esplen MJ, Garfinkel PE, Olmsted M, Gallop RM, Kennedy S. Source: Psychological Medicine. 1998 November; 28(6): 1347-57. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9854276&dopt=Abstract

·

Binge eating disorder: prevalence and psychopathological features in a clinical sample of obese people in Italy. Author(s): Ramacciotti CE, Coli E, Passaglia C, Lacorte M, Pea E, Dell'Osso L. Source: Psychiatry Research. 2000 May 15; 94(2): 131-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10808038&dopt=Abstract

·

Body dissatisfaction and its interrelations with other risk factors for bulimia nervosa in 12 countries. Author(s): Jaeger B, Ruggiero GM, Edlund B, Gomez-Perretta C, Lang F, Mohammadkhani P, Sahleen-Veasey C, Schomer H, Lamprecht F.


Source: Psychotherapy and Psychosomatics. 2002 January-February; 71(1): 54-61. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11740169&dopt=Abstract ·

Bulimia nervosa in the Chinese. Author(s): Schmidt U. Source: The International Journal of Eating Disorders. 1993 December; 14(4): 505-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8293034&dopt=Abstract

·

Bulimia nervosa in two cultures: a comparison of Austrian and American college students. Author(s): Mangweth B, Pope HG, Hudson JI. Source: The International Journal of Eating Disorders. 1995 May; 17(4): 403-12. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7620481&dopt=Abstract

·

Bulimia nervosa: a 5-year follow-up study. Author(s): Johnson-Sabine E, Reiss D, Dayson D. Source: Psychological Medicine. 1992 November; 22(4): 951-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1488490&dopt=Abstract

·

Clinical implications of psychosocial research on bulimia nervosa and binge-eating disorder. Author(s): Stice E. Source: Journal of Clinical Psychology. 1999 June; 55(6): 675-83. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10445859&dopt=Abstract

·

Cognitive behavior therapy for eating disorders: progress and problems. Author(s): Wilson GT. Source: Behaviour Research and Therapy. 1999 July; 37 Suppl 1: S79-95. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10402697&dopt=Abstract


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Cognitive-behavioral self-help for binge eating disorder: a controlled effectiveness study. Author(s): Carter JC, Fairburn CG. Source: J Consult Clin Psychol. 1998 August; 66(4): 616-23. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9735577&dopt=Abstract

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Dependency and eating disorders in female psychiatric inpatients. Author(s): Bornstein RF, Greenberg RP. Source: The Journal of Nervous and Mental Disease. 1991 March; 179(3): 148-52. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1997662&dopt=Abstract

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Differences in salivary habituation to palatable foods in bulimia nervosa patients and controls. Author(s): Wisniewski L, Epstein LH, Marcus MD, Kaye W. Source: Psychosomatic Medicine. 1997 July-August; 59(4): 427-33. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9251163&dopt=Abstract

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Eating disorders and adolescents: an overview of a maladaptive behavior. Author(s): Grothaus KL. Source: Journal of Child and Adolescent Psychiatric Nursing : Official Publication of the Association of Child and Adolescent Psychiatric Nurses, Inc. 1998 October-December; 11(4): 146-56. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10067478&dopt=Abstract

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Eating disorders in a nonclinical adolescent population: implications for treatment. Author(s): Lachenmeyer JR, Muni-Brander P. Source: Adolescence. 1988 Summer; 23(90): 303-12. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=3261484&dopt=Abstract

·

Eating disorders: a strategic approach. Author(s): Launer M.


Source: Practitioner. 2000 February; 244(1607): 129-32, 134-6. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10892046&dopt=Abstract ·

Food deprivation and emotional reactions to food cues: implications for eating disorders. Author(s): Drobes DJ, Miller EJ, Hillman CH, Bradley MM, Cuthbert BN, Lang PJ. Source: Biological Psychology. 2001 July-August; 57(1-3): 153-77. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11454438&dopt=Abstract

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Guided imagery treatment to promote self-soothing in bulimia nervosa. A theoretical rationale. Author(s): Esplen MJ, Garfinkel PE. Source: The Journal of Psychotherapy Practice and Research. 1998 Spring; 7(2): 102-18. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9527955&dopt=Abstract

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Hypnotizability, dissociation, and bulimia nervosa. Author(s): Covino NA, Jimerson DC, Wolfe BE, Franko DL, Frankel FH. Source: Journal of Abnormal Psychology. 1994 August; 103(3): 455-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7930044&dopt=Abstract

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Imagery rescripting within cognitive behavior therapy for bulimia nervosa: an illustrative case report. Author(s): Ohanian V. Source: The International Journal of Eating Disorders. 2002 April; 31(3): 352-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11921000&dopt=Abstract

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Irene, a case study of a bulimia nervosa patient: the therapeutic process of integrative painting therapy. Author(s): Steinbauer M, Muller M, Laure S, Zapotoczky HG. Source: Eat Weight Disord. 1999 June; 4(2): 95-102. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11234248&dopt=Abstract


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Married patients with eating disorders in Japan. Author(s): Kiriike N, Nagata T, Matsunaga H, Tobitani W, Nishiura T. Source: Acta Psychiatrica Scandinavica. 1996 December; 94(6): 428-32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9020994&dopt=Abstract

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Psychological characteristics and biofeedback mitigation in preadolescents with eating disorders. Author(s): Pop-Jordanova N. Source: Pediatrics International : Official Journal of the Japan Pediatric Society. 2000 February; 42(1): 76-81. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10703241&dopt=Abstract

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Relation of dissociative phenomena to levels of cerebrospinal fluid monoamine metabolites and beta-endorphin in patients with eating disorders: a pilot study. Author(s): Demitrack MA, Putnam FW, Rubinow DR, Pigott TA, Altemus M, Krahn DD, Gold PW. Source: Psychiatry Research. 1993 October; 49(1): 1-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7511247&dopt=Abstract

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Relationship between self-soothing, aloneness, and evocative memory in bulimia nervosa. Author(s): Esplen MJ, Garfinkel P, Gallop R. Source: The International Journal of Eating Disorders. 2000 January; 27(1): 96-100. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10590454&dopt=Abstract

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Sauna abuse as a clinical feature of bulimia nervosa. Author(s): Mitchell JE, Pyle RL, Eckert E. Source: Psychosomatics. 1991 Fall; 32(4): 417-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1961855&dopt=Abstract

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Selective processing of shape-related words in women with eating disorders, and those who have recovered. Author(s): Lovell DM, Williams JM, Hill AB.


Source: The British Journal of Clinical Psychology / the British Psychological Society. 1997 September; 36 ( Pt 3): 421-32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9309357&dopt=Abstract ·

Self-help versus therapist-led group cognitive-behavioral treatment of binge eating disorder at follow-up. Author(s): Peterson CB, Mitchell JE, Engbloom S, Nugent S, Pederson Mussell M, Crow SJ, Thuras P. Source: The International Journal of Eating Disorders. 2001 December; 30(4): 363-74. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11746298&dopt=Abstract

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Stepped care treatment for eating disorders. Author(s): Wilson GT, Vitousek KM, Loeb KL. Source: J Consult Clin Psychol. 2000 August; 68(4): 564-72. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10965631&dopt=Abstract

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The eating disorders as addiction: a psychobiological perspective. Author(s): Davis C, Claridge G. Source: Addictive Behaviors. 1998 July-August; 23(4): 463-75. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9698975&dopt=Abstract

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The role of exposure with response prevention in the cognitivebehavioural therapy for bulimia nervosa. Author(s): Bulik CM, Sullivan PF, Carter FA, McIntosh VV, Joyce PR. Source: Psychological Medicine. 1998 May; 28(3): 611-23. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9626717&dopt=Abstract

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The stepped-care approach in anorexia nervosa and bulimia nervosa: progress and problems. Author(s): Dalle Grave R, Ricca V, Todesco T. Source: Eat Weight Disord. 2001 June; 6(2): 81-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11456425&dopt=Abstract

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The treatment of bulimia nervosa. Author(s): Griffiths RA, Touyz SW, Mitchell PB, Bacon W.


Source: The Australian and New Zealand Journal of Psychiatry. 1987 March; 21(1): 5-15. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=3476108&dopt=Abstract ·

The use of hypnosis in the treatment of bulimia nervosa. Author(s): Vanderlinden J, Vandereycken W. Source: Int J Clin Exp Hypn. 1990 April; 38(2): 101-11. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=2189837&dopt=Abstract

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The use of hypnosis with eating disorders. Author(s): Torem MS. Source: Psychiatr Med. 1992; 10(4): 105-18. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1289956&dopt=Abstract

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Treatment of bulimia nervosa: when CBT fails. Author(s): Wilson GT. Source: Behaviour Research and Therapy. 1996 March; 34(3): 197-212. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8881090&dopt=Abstract

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Use of hypnosis in eating disorders. Author(s): Gross M. Source: New Dir Ment Health Serv. 1986 Fall; (31): 109-18. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=3785121&dopt=Abstract

Additional Web Resources A number of additional Web sites offer encyclopedic information covering CAM and related topics. The following is a representative sample: ·

Alternative Medicine Foundation, Inc.: http://www.herbmed.org/

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Chinese Medicine: http://www.newcenturynutrition.com/


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drkoop.comÒ: http://www.drkoop.com/InteractiveMedicine/IndexC.html

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Family Village: http://www.familyvillage.wisc.edu/med_altn.htm

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Google: http://directory.google.com/Top/Health/Alternative/

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Healthnotes: http://www.thedacare.org/healthnotes/

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Open Directory Project: http://dmoz.org/Health/Alternative/

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TPN.com: http://www.tnp.com/

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Yahoo.com: http://dir.yahoo.com/Health/Alternative_Medicine/

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WebMDÒHealth: http://my.webmd.com/drugs_and_herbs

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WellNet: http://www.wellnet.ca/herbsa-c.htm

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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,,00.html

The following is a specific Web list relating to binge eating disorder; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: ·

General Overview Bulimia Nervosa Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Bulimi aNervosacc.html Eating Disorders Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Eating_Disorders.htm

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Herbs and Supplements 5-HTP Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Eating_Disorders.htm


5-Hydroxytryptophan Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Eating_Disorders.htm Antidepressants Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Bulimi aNervosacc.html Diuretics Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Eating_Disorders.htm Diuretics Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Bulimi aNervosacc.html Imipramine Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Eating_Disorders.htm Insulin Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Eating_Disorders.htm Selective Serotonin Reuptake Inhibitors Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Eating_Disorders.htm SSRIs Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Bulimi aNervosacc.html


St. John's Wort Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Bulimi aNervosacc.html Tricyclic Antidepressants Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Bulimi aNervosacc.html ·

Related Conditions Anorexia Nervosa Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Anorex iaNervosacc.html Eating Disorders, Anorexia Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Anorex iaNervosacc.html Eating Disorders, Bulimia Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Bulimi aNervosacc.html

General References A good place to find general background information on CAM is the National Library of Medicine. It has prepared within the MEDLINEplus system an information topic page dedicated to complementary and alternative medicine. To access this page, go to the MEDLINEplus site at: www.nlm.nih.gov/medlineplus/alternativemedicine.html. This Web site provides a general overview of various topics and can lead to a number of general sources. The following additional references describe, in broad terms, alternative and complementary medicine (sorted alphabetically by


title; hyperlinks Amazon.com):

provide

rankings,

information,

and

reviews

at

· Alternative Medicine for Dummies by James Dillard (Author); Audio Cassette, Abridged edition (1998), Harper Audio; ISBN: 0694520659; http://www.amazon.com/exec/obidos/ASIN/0694520659/icongroupinterna ·

Complementary and Alternative Medicine Secrets by W. Kohatsu (Editor); Hardcover (2001), Hanley & Belfus; ISBN: 1560534400; http://www.amazon.com/exec/obidos/ASIN/1560534400/icongroupinterna

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Dictionary of Alternative Medicine by J. C. Segen; Paperback-2nd edition (2001), Appleton & Lange; ISBN: 0838516211; http://www.amazon.com/exec/obidos/ASIN/0838516211/icongroupinterna

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Eat, Drink, and Be Healthy: The Harvard Medical School Guide to Healthy Eating by Walter C. Willett, MD, et al; Hardcover - 352 pages (2001), Simon & Schuster; ISBN: 0684863375; http://www.amazon.com/exec/obidos/ASIN/0684863375/icongroupinterna

· Encyclopedia of Natural Medicine, Revised 2nd Edition by Michael T. Murray, Joseph E. Pizzorno; Paperback - 960 pages, 2nd Rev edition (1997), Prima Publishing; ISBN: 0761511571; http://www.amazon.com/exec/obidos/ASIN/0761511571/icongroupinterna ·

Integrative Medicine: An Introduction to the Art & Science of Healing by Andrew Weil (Author); Audio Cassette, Unabridged edition (2001), Sounds True; ISBN: 1564558541; http://www.amazon.com/exec/obidos/ASIN/1564558541/icongroupinterna

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New Encyclopedia of Herbs & Their Uses by Deni Bown; Hardcover - 448 pages, Revised edition (2001), DK Publishing; ISBN: 078948031X; http://www.amazon.com/exec/obidos/ASIN/078948031X/icongroupinterna

· Textbook of Complementary and Alternative Medicine by Wayne B. Jonas; Hardcover (2003), Lippincott, Williams & Wilkins; ISBN: 0683044370; http://www.amazon.com/exec/obidos/ASIN/0683044370/icongroupinterna For additional information on complementary and alternative medicine, ask your doctor or write to: National Institutes of Health National Center for Complementary and Alternative Medicine Clearinghouse P. O. Box 8218 Silver Spring, MD 20907-8218

Researching Nutrition 151

APPENDIX C. RESEARCHING NUTRITION Overview Since the time of Hippocrates, doctors have understood the importance of diet and nutrition to patients’ health and well-being. Since then, they have accumulated an impressive archive of studies and knowledge dedicated to this subject. Based on their experience, doctors and healthcare providers may recommend particular dietary supplements to patients with binge eating disorder. Any dietary recommendation is based on a patient’s age, body mass, gender, lifestyle, eating habits, food preferences, and health condition. It is therefore likely that different patients with binge eating disorder may be given different recommendations. Some recommendations may be directly related to binge eating disorder, while others may be more related to the patient’s general health. These recommendations, themselves, may differ from what official sources recommend for the average person. In this chapter we will begin by briefly reviewing the essentials of diet and nutrition that will broadly frame more detailed discussions of binge eating disorder. We will then show you how to find studies dedicated specifically to nutrition and binge eating disorder.


Food and Nutrition: General Principles What Are Essential Foods? Food is generally viewed by official sources as consisting of six basic elements: (1) fluids, (2) carbohydrates, (3) protein, (4) fats, (5) vitamins, and (6) minerals. Consuming a combination of these elements is considered to be a healthy diet: ·

Fluids are essential to human life as 80-percent of the body is composed of water. Water is lost via urination, sweating, diarrhea, vomiting, diuretics (drugs that increase urination), caffeine, and physical exertion.

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Carbohydrates are the main source for human energy (thermoregulation) and the bulk of typical diets. They are mostly classified as being either simple or complex. Simple carbohydrates include sugars which are often consumed in the form of cookies, candies, or cakes. Complex carbohydrates consist of starches and dietary fibers. Starches are consumed in the form of pastas, breads, potatoes, rice, and other foods. Soluble fibers can be eaten in the form of certain vegetables, fruits, oats, and legumes. Insoluble fibers include brown rice, whole grains, certain fruits, wheat bran and legumes.

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Proteins are eaten to build and repair human tissues. Some foods that are high in protein are also high in fat and calories. Food sources for protein include nuts, meat, fish, cheese, and other dairy products.

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Fats are consumed for both energy and the absorption of certain vitamins. There are many types of fats, with many general publications recommending the intake of unsaturated fats or those low in cholesterol.

Vitamins and minerals are fundamental to human health, growth, and, in some cases, disease prevention. Most are consumed in your diet (exceptions being vitamins K and D which are produced by intestinal bacteria and sunlight on the skin, respectively). Each vitamin and mineral plays a different role in health. The following outlines essential vitamins: ·

Vitamin A is important to the health of your eyes, hair, bones, and skin; sources of vitamin A include foods such as eggs, carrots, and cantaloupe.

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Vitamin B1, also known as thiamine, is important for your nervous system and energy production; food sources for thiamine include meat, peas, fortified cereals, bread, and whole grains.

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Vitamin B2, also known as riboflavin, is important for your nervous system and muscles, but is also involved in the release of proteins from


nutrients; food sources for riboflavin include dairy products, leafy vegetables, meat, and eggs. ·

Vitamin B3, also known as niacin, is important for healthy skin and helps the body use energy; food sources for niacin include peas, peanuts, fish, and whole grains

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Vitamin B6, also known as pyridoxine, is important for the regulation of cells in the nervous system and is vital for blood formation; food sources for pyridoxine include bananas, whole grains, meat, and fish.

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Vitamin B12 is vital for a healthy nervous system and for the growth of red blood cells in bone marrow; food sources for vitamin B12 include yeast, milk, fish, eggs, and meat.

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Vitamin C allows the body’s immune system to fight various diseases, strengthens body tissue, and improves the body’s use of iron; food sources for vitamin C include a wide variety of fruits and vegetables.

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Vitamin D helps the body absorb calcium which strengthens bones and teeth; food sources for vitamin D include oily fish and dairy products.

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Vitamin E can help protect certain organs and tissues from various degenerative diseases; food sources for vitamin E include margarine, vegetables, eggs, and fish.

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Vitamin K is essential for bone formation and blood clotting; common food sources for vitamin K include leafy green vegetables.

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Folic Acid maintains healthy cells and blood and, when taken by a pregnant woman, can prevent her fetus from developing neural tube defects; food sources for folic acid include nuts, fortified breads, leafy green vegetables, and whole grains.

It should be noted that one can overdose on certain vitamins which become toxic if consumed in excess (e.g. vitamin A, D, E and K). Like vitamins, minerals are chemicals that are required by the body to remain in good health. Because the human body does not manufacture these chemicals internally, we obtain them from food and other dietary sources. The more important minerals include: ·

Calcium is needed for healthy bones, teeth, and muscles, but also helps the nervous system function; food sources for calcium include dry beans, peas, eggs, and dairy products.

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Chromium is helpful in regulating sugar levels in blood; food sources for chromium include egg yolks, raw sugar, cheese, nuts, beets, whole grains, and meat.


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Fluoride is used by the body to help prevent tooth decay and to reinforce bone strength; sources of fluoride include drinking water and certain brands of toothpaste.

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Iodine helps regulate the body’s use of energy by synthesizing into the hormone thyroxine; food sources include leafy green vegetables, nuts, egg yolks, and red meat.

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Iron helps maintain muscles and the formation of red blood cells and certain proteins; food sources for iron include meat, dairy products, eggs, and leafy green vegetables.

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Magnesium is important for the production of DNA, as well as for healthy teeth, bones, muscles, and nerves; food sources for magnesium include dried fruit, dark green vegetables, nuts, and seafood.

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Phosphorous is used by the body to work with calcium to form bones and teeth; food sources for phosphorous include eggs, meat, cereals, and dairy products.

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Selenium primarily helps maintain normal heart and liver functions; food sources for selenium include wholegrain cereals, fish, meat, and dairy products.

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Zinc helps wounds heal, the formation of sperm, and encourage rapid growth and energy; food sources include dried beans, shellfish, eggs, and nuts.

The United States government periodically publishes recommended diets and consumption levels of the various elements of food. Again, your doctor may encourage deviations from the average official recommendation based on your specific condition. To learn more about basic dietary guidelines, visit the Web site: http://www.health.gov/dietaryguidelines/. Based on these guidelines, many foods are required to list the nutrition levels on the food’s packaging. Labeling Requirements are listed at the following site maintained by the Food and Drug Administration: http://www.cfsan.fda.gov/~dms/labcons.html. When interpreting these requirements, the government recommends that consumers become familiar with the following abbreviations before reading FDA literature:44 ·

DVs (Daily Values): A new dietary reference term that will appear on the food label. It is made up of two sets of references, DRVs and RDIs.

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DRVs (Daily Reference Values): A set of dietary references that applies to fat, saturated fat, cholesterol, carbohydrate, protein, fiber, sodium, and potassium.

44

Adapted from the FDA: http://www.fda.gov/fdac/special/foodlabel/dvs.html.


·

RDIs (Reference Daily Intakes): A set of dietary references based on the Recommended Dietary Allowances for essential vitamins and minerals and, in selected groups, protein. The name “RDI” replaces the term “U.S. RDA.”

·

RDAs (Recommended Dietary Allowances): A set of estimated nutrient allowances established by the National Academy of Sciences. It is updated periodically to reflect current scientific knowledge. What Are Dietary Supplements?45

Dietary supplements are widely available through many commercial sources, including health food stores, grocery stores, pharmacies, and by mail. Dietary supplements are provided in many forms including tablets, capsules, powders, gel-tabs, extracts, and liquids. Historically in the United States, the most prevalent type of dietary supplement was a multivitamin/mineral tablet or capsule that was available in pharmacies, either by prescription or “over the counter.” Supplements containing strictly herbal preparations were less widely available. Currently in the United States, a wide array of supplement products are available, including vitamin, mineral, other nutrients, and botanical supplements as well as ingredients and extracts of animal and plant origin. The Office of Dietary Supplements (ODS) of the National Institutes of Health is the official agency of the United States which has the expressed goal of acquiring “new knowledge to help prevent, detect, diagnose, and treat disease and disability, from the rarest genetic disorder to the common cold.”46 According to the ODS, dietary supplements can have an important impact on the prevention and management of disease and on the maintenance of health.47 The ODS notes that considerable research on the effects of dietary supplements has been conducted in Asia and Europe where the use of plant products, in particular, has a long tradition. However, the This discussion has been adapted from the NIH: http://ods.od.nih.gov/whatare/whatare.html. 46 Contact: The Office of Dietary Supplements, National Institutes of Health, Building 31, Room 1B29, 31 Center Drive, MSC 2086, Bethesda, Maryland 20892-2086, Tel: (301) 435-2920, Fax: (301) 480-1845, E-mail: [email protected]. 47 Adapted from http://ods.od.nih.gov/about/about.html. The Dietary Supplement Health and Education Act defines dietary supplements as “a product (other than tobacco) intended to supplement the diet that bears or contains one or more of the following dietary ingredients: a vitamin, mineral, amino acid, herb or other botanical; or a dietary substance for use to supplement the diet by increasing the total dietary intake; or a concentrate, metabolite, constituent, extract, or combination of any ingredient described above; and intended for ingestion in the form of a capsule, powder, softgel, or gelcap, and not represented as a conventional food or as a sole item of a meal or the diet.” 45


overwhelming majority of supplements have not been studied scientifically. To explore the role of dietary supplements in the improvement of health care, the ODS plans, organizes, and supports conferences, workshops, and symposia on scientific topics related to dietary supplements. The ODS often works in conjunction with other NIH Institutes and Centers, other government agencies, professional organizations, and public advocacy groups. To learn more about official information on dietary supplements, visit the ODS site at http://ods.od.nih.gov/whatare/whatare.html. Or contact: The Office of Dietary Supplements National Institutes of Health Building 31, Room 1B29 31 Center Drive, MSC 2086 Bethesda, Maryland 20892-2086 Tel: (301) 435-2920 Fax: (301) 480-1845 E-mail: [email protected]

Finding Studies on Binge Eating Disorder The NIH maintains an office dedicated to patient nutrition and diet. The National Institutes of Health’s Office of Dietary Supplements (ODS) offers a searchable bibliographic database called the IBIDS (International Bibliographic Information on Dietary Supplements). The IBIDS contains over 460,000 scientific citations and summaries about dietary supplements and nutrition as well as references to published international, scientific literature on dietary supplements such as vitamins, minerals, and botanicals.48 IBIDS is available to the public free of charge through the ODS Internet page: http://ods.od.nih.gov/databases/ibids.html. After entering the search area, you have three choices: (1) IBIDS Consumer Database, (2) Full IBIDS Database, or (3) Peer Reviewed Citations Only. We recommend that you start with the Consumer Database. While you may not find references for the topics that are of most interest to you, check back periodically as this database is frequently updated. More studies can be Adapted from http://ods.od.nih.gov. IBIDS is produced by the Office of Dietary Supplements (ODS) at the National Institutes of Health to assist the public, healthcare providers, educators, and researchers in locating credible, scientific information on dietary supplements. IBIDS was developed and will be maintained through an interagency partnership with the Food and Nutrition Information Center of the National Agricultural Library, U.S. Department of Agriculture.

48


found by searching the Full IBIDS Database. Healthcare professionals and researchers generally use the third option, which lists peer-reviewed citations. In all cases, we suggest that you take advantage of the “Advanced Search” option that allows you to retrieve up to 100 fully explained references in a comprehensive format. Type “binge eating disorder” (or synonyms) into the search box. To narrow the search, you can also select the “Title” field. The following is a typical result when searching for recently indexed consumer information on binge eating disorder: ·

Eating disorders and IDDM. A problematic association. Author(s): Department of Psychiatry, Toronto Hospital, University of Toronto, Ontario, Canada. Source: Rodin, G M Daneman, D Diabetes-Care. 1992 October; 15(10): 1402-12 0149-5992

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Eating disorders in adolescents with IDDM. A controlled study. Author(s): University Department of Psychiatry, Warneford Hospital, Oxford, UK. Source: Peveler, R C Fairburn, C G Boller, I Dunger, D Diabetes-Care. 1992 October; 15(10): 1356-60 0149-5992

·

Subclinical and clinical eating disorders in IDDM negatively affect metabolic control. Author(s): Department of Nutritional Sciences, University of Connecticut, Storrs 06269, USA. [email protected] Source: Affenito, S G Backstrand, J R Welch, G W Lammi Keefe, C J Rodriguez, N R Adams, C H Diabetes-Care. 1997 February; 20(2): 182-4 0149-5992

·

The dietitian's role in the treatment of eating disorders. Source: Roche, H.M. BNF-nutr-bull. London : The British Nutrition Foundation. March 2000. volume 25 (1) page 55-60. 0141-9684

The following information is typical of that found when using the “Full IBIDS Database” when searching using “binge eating disorder” (or a synonym): ·

Behavioral, psychological, and physical characteristics of female athletes with subclinical eating disorders. Author(s): Department of Family Consumer Sciences, Ball State University, Muncie, IN 47306, USA. Source: Beals, K A Manore, M M Int-J-Sport-Nutr-Exerc-Metab. 2000 June; 10(2): 128-43 1526-484X


·

Binge eating disorder affects outcome of comprehensive very-lowcalorie diet treatment. Source: Yanovski, S.Z. Gormally, J.F. Leser, M.S. Gwirtsman, H.E. Yanovski, J.A. Obes-res. Baton Rouge, LA : North American Association for the Study of Obesity, c1993-. May 1994. volume 2 (3) page 205-212. 1071-7323

·

Binge eating disorder and bulimia nervosa: differences in the quality and quantity of binge eating episodes. Source: Fitzgibbon, M.L. Blackman, L.R. Int-j-eat-disord. New York, N.Y. John Wiley & Sons, Inc. March 2000. volume 27 (2) page 238-243. 0276-3478

·

Binge eating disorder, weight cycling, and psychopathology. Author(s): Syracuse University. Source: Kuehnel, R H Wadden, T A Int-J-Eat-Disord. 1994 May; 15(4): 321-9 0276-3478

·

Clinical implications of psychosocial research on bulimia nervosa and binge-eating disorder. Author(s): Department of Psychology, University of Texas at Austin, 78712, USA. Source: Stice, E J-Clin-Psychol. 1999 June; 55(6): 675-83 0021-9762

·

Cognitive behavioral therapy for the treatment of binge eating disorder: what constitutes success? Author(s): Department of Psychiatry, Columbia College of Physicians and Surgeons, New York, NY 10032, USA. [email protected] Source: Goldfein, J A Devlin, M J Spitzer, R L Am-J-Psychiatry. 2000 July; 157(7): 1051-6 0002-953X

·

Cognitive bias in eating disorders: implications for theory and treatment. Author(s): Department of Psychology, Louisiana State University, Baton Rouge 70803, USA. Source: Williamson, D A Muller, S L Reas, D L Thaw, J M Behav-Modif. 1999 October; 23(4): 556-77 0145-4455

·

Cognitive-behavioral therapy for bulimia nervosa: an illustration. Author(s): Department of Psychology, Brigham Young University, Provo, UT 84602, USA. Source: Spangler, D L J-Clin-Psychol. 1999 June; 55(6): 699-713 0021-9762

·

Commentary. IV. Eating disorders: the transitory state of science and treatment. Source: Goldbloom, D.S. Jeejeebhoy, K.N. Bristol-Myers-Squibb-MeadJohnson-Nutr-Symp. San Diego, Calif. : Academic Press. 1992. volume 10 page 387-392.


·

Congress asked to take eating disorders seriously. Source: Berg, F.M. Healthy-weight-j. Hanover, PA : The Sheridan Press. May/June 1998. volume 12 (3) page 41-43. 1075-0169

·

Dental aspects of anorexia and bulimia nervosa. Author(s): National Institute of Dental Research, Bethesda, Md. Source: Roberts, M W Tylenda, C A Pediatrician. 1989; 16(3-4): 178-84 0300-1245

·

Differences between adolescents and young adults at presentation to an eating disorders program. Author(s): Division of Adolescent Medicine, North Shore University Hospital, Manhasset, New York 11030, USA. [email protected] Source: Fisher, M Schneider, M Burns, J Symons, H Mandel, F S JAdolesc-Health. 2001 March; 28(3): 222-7 1054-139X

·

Gastrointestinal and nutritional aspects of eating disorders. Source: McClain, C.J. Humphries, L.L. Hill, K.K. Nickl, N.J. J-Am-CollNutr. Wilmington, NC : American College of Nutrition. August 1993. volume 12 (4) page 466-474. 0731-5724

·

Genetic and environmental risk factors for the weight and shape concerns characteristic of bulimia nervosa. Author(s): School of Psychology, Flinders University of South Australia, Brisbane, Australia. Source: Wade, T Martin, N G Tiggemann, M Psychol-Med. 1998 July; 28(4): 761-71 0033-2917

·

Nocturnal eating in binge eating disorder and matched-weight controls. Author(s): Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, PA, USA. Source: Greeno, C G Wing, R R Marcus, M D Int-J-Eat-Disord. 1995 December; 18(4): 343-9 0276-3478

·

Nutritional implications for the treatment of anorexia nervosa and bulimia nervosa. Source: Pencharz, P.B. Azcue, M. Vaisman, N. Bristol-Myers-SquibbMead-Johnson-Nutr-Symp. San Diego, Calif. : Academic Press. 1992. volume 10 page 357-367.

·

Obese women with binge eating disorder define the term binge. Source: Telch, C.F. Pratt, E.M. Niego, S.H. Int-j-eat-disord. New York, N.Y. : John Wiley & Sons, Inc. November 1998. volume 24 (3) page 313-317. 0276-3478


·

Osteoporosis and eating disorders. Author(s): Department of Psychiatry and Behavioral Medicine, College of Medicine, University of South Florida, Tampa, USA. Source: Powers, P S J-Pediatr-Adolesc-Gynecol. 1999 May; 12(2): 51-7 1083-3188

·

Sensory preferences and fat consumption in obesity and eating disorders. Source: Drewnowski, A. Dietary fats determinants of preference, selection, and consumption / edited by DJ Mela. London : New York : Elsevier Applied Science, c1992.. page 59-77. ISBN: 1851668659

·

Serotonin in human eating disorders. Author(s): Department of Psychiatry, Beth Israel Hospital, Boston, Massachusetts 02215. Source: Jimerson, D C Lesem, M D Hegg, A P Brewerton, T D Ann-N-YAcad-Sci. 1990; 600532-44 0077-8923

Federal Resources on Nutrition In addition to the IBIDS, the United States Department of Health and Human Services (HHS) and the United States Department of Agriculture (USDA) provide many sources of information on general nutrition and health. Recommended resources include: ·

healthfinder®, HHS’s gateway to health information, including diet and nutrition: http://www.healthfinder.gov/scripts/SearchContext.asp?topic=238&page=0

·

The United States Department of Agriculture’s Web site dedicated to nutrition information: www.nutrition.gov

·

The Food and Drug Administration’s Web site for federal food safety information: www.foodsafety.gov

·

The National Action Plan on Overweight and Obesity sponsored by the United States Surgeon General: http://www.surgeongeneral.gov/topics/obesity/

·

The Center for Food Safety and Applied Nutrition has an Internet site sponsored by the Food and Drug Administration and the Department of Health and Human Services: http://vm.cfsan.fda.gov/

·

Center for Nutrition Policy and Promotion sponsored by the United States Department of Agriculture: http://www.usda.gov/cnpp/


·

Food and Nutrition Information Center, National Agricultural Library sponsored by the United States Department of Agriculture: http://www.nal.usda.gov/fnic/

·

Food and Nutrition Service sponsored by the United States Department of Agriculture: http://www.fns.usda.gov/fns/

Additional Web Resources A number of additional Web sites offer encyclopedic information covering food and nutrition. The following is a representative sample: ·


·

Family Village: http://www.familyvillage.wisc.edu/med_nutrition.html

·

Google: http://directory.google.com/Top/Health/Nutrition/

·

Healthnotes: http://www.thedacare.org/healthnotes/

·

Open Directory Project: http://dmoz.org/Health/Nutrition/

·

Yahoo.com: http://dir.yahoo.com/Health/Nutrition/

·

WebMDÒHealth: http://my.webmd.com/nutrition

·

WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,,00.html

The following is a specific Web list relating to binge eating disorder; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: ·

Minerals Copper Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Eating_Disorders.htm Folate Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Eating_Disorders.htm


·

Food and Diet Flour Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Eating_Disorders.htm Pike Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Eating_Disorders.htm Sugar Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Eating_Disorders.htm Sugar Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Bulimi aNervosacc.html Weight Loss Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Eating_Disorders.htm

Vocabulary Builder The following vocabulary builder defines words used in the references in this chapter that have not been defined in previous chapters: Bacteria: Unicellular prokaryotic microorganisms which generally possess rigid cell walls, multiply by cell division, and exhibit three principal forms: round or coccal, rodlike or bacillary, and spiral or spirochetal. [NIH] Capsules: Hard or soft soluble containers used for the oral administration of medicine. [NIH] Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU]


Diarrhea: Passage of excessively liquid or excessively frequent stools. [NIH] Iodine: A nonmetallic element of the halogen group that is represented by the atomic symbol I, atomic number 53, and atomic weight of 126.90. It is a nutritionally essential element, especially important in thyroid hormone synthesis. In solution, it has anti-infective properties and is used topically. [NIH]

Neural: 1. pertaining to a nerve or to the nerves. 2. situated in the region of the spinal axis, as the neutral arch. [EU] Niacin: Water-soluble vitamin of the B complex occurring in various animal and plant tissues. Required by the body for the formation of coenzymes NAD and NADP. Has pellagra-curative, vasodilating, and antilipemic properties. [NIH] Osteoporosis: Reduction in the amount of bone mass, leading to fractures after minimal trauma. [EU] Overdose: 1. to administer an excessive dose. 2. an excessive dose. [EU] Potassium: An element that is in the alkali group of metals. It has an atomic symbol K, atomic number 19, and atomic weight 39.10. It is the chief cation in the intracellular fluid of muscle and other cells. Potassium ion is a strong electrolyte and it plays a significant role in the regulation of fluid volume and maintenance of the water-electrolyte balance. [NIH] Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH]

Riboflavin: Nutritional factor found in milk, eggs, malted barley, liver, kidney, heart, and leafy vegetables. The richest natural source is yeast. It occurs in the free form only in the retina of the eye, in whey, and in urine; its principal forms in tissues and cells are as FMN and FAD. [NIH] Selenium: An element with the atomic symbol Se, atomic number 34, and atomic weight 78.96. It is an essential micronutrient for mammals and other animals but is toxic in large amounts. Selenium protects intracellular structures against oxidative damage. It is an essential component of glutathione peroxidase. [NIH] Thyroxine: An amino acid of the thyroid gland which exerts a stimulating effect on thyroid metabolism. [NIH]

Finding Medical Libraries 165

APPENDIX D. FINDING MEDICAL LIBRARIES Overview At a medical library you can find medical texts and reference books, consumer health publications, specialty newspapers and magazines, as well as medical journals. In this Appendix, we show you how to quickly find a medical library in your area.

Preparation Before going to the library, highlight the references mentioned in this sourcebook that you find interesting. Focus on those items that are not available via the Internet, and ask the reference librarian for help with your search. He or she may know of additional resources that could be helpful to you. Most importantly, your local public library and medical libraries have Interlibrary Loan programs with the National Library of Medicine (NLM), one of the largest medical collections in the world. According to the NLM, most of the literature in the general and historical collections of the National Library of Medicine is available on interlibrary loan to any library. NLM’s interlibrary loan services are only available to libraries. If you would like to access NLM medical literature, then visit a library in your area that can request the publications for you.49

49

Adapted from the NLM: http://www.nlm.nih.gov/psd/cas/interlibrary.html.


Finding a Local Medical Library The quickest method to locate medical libraries is to use the Internet-based directory published by the National Network of Libraries of Medicine (NN/LM). This network includes 4626 members and affiliates that provide many services to librarians, health professionals, and the public. To find a library in your area, simply visit http://nnlm.gov/members/adv.html or call 1-800-338-7657.

Medical Libraries Open to the Public In addition to the NN/LM, the National Library of Medicine (NLM) lists a number of libraries that are generally open to the public and have reference facilities. The following is the NLM’s list plus hyperlinks to each library Web site. These Web pages can provide information on hours of operation and other restrictions. The list below is a small sample of libraries recommended by the National Library of Medicine (sorted alphabetically by name of the U.S. state or Canadian province where the library is located):50 ·

Alabama: Health InfoNet of Jefferson County (Jefferson County Library Cooperative, Lister Hill Library of the Health Sciences), http://www.uab.edu/infonet/

·

Alabama: Richard M. Scrushy Library (American Sports Medicine Institute), http://www.asmi.org/LIBRARY.HTM

·

Arizona: Samaritan Regional Medical Center: The Learning Center (Samaritan Health System, Phoenix, Arizona), http://www.samaritan.edu/library/bannerlibs.htm

·

California: Kris Kelly Health Information Center (St. Joseph Health System), http://www.humboldt1.com/~kkhic/index.html

·

California: Community Health Library of Los Gatos (Community Health Library of Los Gatos), http://www.healthlib.org/orgresources.html

·

California: Consumer Health Program and Services (CHIPS) (County of Los Angeles Public Library, Los Angeles County Harbor-UCLA Medical Center Library) - Carson, CA, http://www.colapublib.org/services/chips.html

·

California: Gateway Health Library (Sutter Gould Medical Foundation)

·

California: Health Library (Stanford University Medical Center), http://www-med.stanford.edu/healthlibrary/

50

Abstracted from http://www.nlm.nih.gov/medlineplus/libraries.html.


·

California: Patient Education Resource Center - Health Information and Resources (University of California, San Francisco), http://sfghdean.ucsf.edu/barnett/PERC/default.asp

·

California: Redwood Health Library (Petaluma Health Care District), http://www.phcd.org/rdwdlib.html

·

California: San José PlaneTree Health Library, http://planetreesanjose.org/

·

California: Sutter Resource Library (Sutter Hospitals Foundation), http://go.sutterhealth.org/comm/resc-library/sac-resources.html

·

California: University of California, Davis. Health Sciences Libraries

·

California: ValleyCare Health Library & Ryan Comer Cancer Resource Center (ValleyCare Health System), http://www.valleycare.com/library.html

·

California: Washington Community Health Resource Library (Washington Community Health Resource Library), http://www.healthlibrary.org/

·

Colorado: William V. Gervasini Memorial Library (Exempla Healthcare), http://www.exempla.org/conslib.htm

·

Connecticut: Hartford Hospital Health Science Libraries (Hartford Hospital), http://www.harthosp.org/library/

·

Connecticut: Healthnet: Connecticut Consumer Health Information Center (University of Connecticut Health Center, Lyman Maynard Stowe Library), http://library.uchc.edu/departm/hnet/

·

Connecticut: Waterbury Hospital Health Center Library (Waterbury Hospital), http://www.waterburyhospital.com/library/consumer.shtml

·

Delaware: Consumer Health Library (Christiana Care Health System, Eugene du Pont Preventive Medicine & Rehabilitation Institute), http://www.christianacare.org/health_guide/health_guide_pmri_health _info.cfm

·

Delaware: Lewis B. Flinn Library (Delaware Academy of Medicine), http://www.delamed.org/chls.html

·

Georgia: Family Resource Library (Medical College of Georgia), http://cmc.mcg.edu/kids_families/fam_resources/fam_res_lib/frl.htm

·

Georgia: Health Resource Center (Medical Center of Central Georgia), http://www.mccg.org/hrc/hrchome.asp

·

Hawaii: Hawaii Medical Library: Consumer Health Information Service (Hawaii Medical Library), http://hml.org/CHIS/


·

Idaho: DeArmond Consumer Health Library (Kootenai Medical Center), http://www.nicon.org/DeArmond/index.htm

·

Illinois: Health Learning Center of Northwestern Memorial Hospital (Northwestern Memorial Hospital, Health Learning Center), http://www.nmh.org/health_info/hlc.html

·

Illinois: Medical Library (OSF Saint Francis Medical Center), http://www.osfsaintfrancis.org/general/library/

·

Kentucky: Medical Library - Services for Patients, Families, Students & the Public (Central Baptist Hospital), http://www.centralbap.com/education/community/library.htm

·

Kentucky: University of Kentucky - Health Information Library (University of Kentucky, Chandler Medical Center, Health Information Library), http://www.mc.uky.edu/PatientEd/

·

Louisiana: Alton Ochsner Medical Foundation Library (Alton Ochsner Medical Foundation), http://www.ochsner.org/library/

·

Louisiana: Louisiana State University Health Sciences Center Medical Library-Shreveport, http://lib-sh.lsuhsc.edu/

·

Maine: Franklin Memorial Hospital Medical Library (Franklin Memorial Hospital), http://www.fchn.org/fmh/lib.htm

·

Maine: Gerrish-True Health Sciences Library (Central Maine Medical Center), http://www.cmmc.org/library/library.html

·

Maine: Hadley Parrot Health Science Library (Eastern Maine Healthcare), http://www.emh.org/hll/hpl/guide.htm

·

Maine: Maine Medical Center Library (Maine Medical Center), http://www.mmc.org/library/

·

Maine: Parkview Hospital, http://www.parkviewhospital.org/communit.htm#Library

·

Maine: Southern Maine Medical Center Health Sciences Library (Southern Maine Medical Center), http://www.smmc.org/services/service.php3?choice=10

·

Maine: Stephens Memorial Hospital Health Information Library (Western Maine Health), http://www.wmhcc.com/hil_frame.html

·

Manitoba, Canada: Consumer & Patient Health Information Service (University of Manitoba Libraries), http://www.umanitoba.ca/libraries/units/health/reference/chis.html

·

Manitoba, Canada: J.W. Crane Memorial Library (Deer Lodge Centre), http://www.deerlodge.mb.ca/library/libraryservices.shtml


·

Maryland: Health Information Center at the Wheaton Regional Library (Montgomery County, Md., Dept. of Public Libraries, Wheaton Regional Library), http://www.mont.lib.md.us/healthinfo/hic.asp

·

Massachusetts: Baystate Medical Center Library (Baystate Health System), http://www.baystatehealth.com/1024/

·

Massachusetts: Boston University Medical Center Alumni Medical Library (Boston University Medical Center), http://medlibwww.bu.edu/library/lib.html

·

Massachusetts: Lowell General Hospital Health Sciences Library (Lowell General Hospital), http://www.lowellgeneral.org/library/HomePageLinks/WWW.htm

·

Massachusetts: Paul E. Woodard Health Sciences Library (New England Baptist Hospital), http://www.nebh.org/health_lib.asp

·

Massachusetts: St. Luke’s Hospital Health Sciences Library (St. Luke’s Hospital), http://www.southcoast.org/library/

·

Massachusetts: Treadwell Library Consumer Health Reference Center (Massachusetts General Hospital), http://www.mgh.harvard.edu/library/chrcindex.html

·

Massachusetts: UMass HealthNet (University of Massachusetts Medical School), http://healthnet.umassmed.edu/

·

Michigan: Botsford General Hospital Library - Consumer Health (Botsford General Hospital, Library & Internet Services), http://www.botsfordlibrary.org/consumer.htm

·

Michigan: Helen DeRoy Medical Library (Providence Hospital and Medical Centers), http://www.providence-hospital.org/library/

·

Michigan: Marquette General Hospital - Consumer Health Library (Marquette General Hospital, Health Information Center), http://www.mgh.org/center.html

·

Michigan: Patient Education Resouce Center - University of Michigan Cancer Center (University of Michigan Comprehensive Cancer Center), http://www.cancer.med.umich.edu/learn/leares.htm

·

Michigan: Sladen Library & Center for Health Information Resources Consumer Health Information, http://www.sladen.hfhs.org/library/consumer/index.html

·

Montana: Center for Health Information (St. Patrick Hospital and Health Sciences Center), http://www.saintpatrick.org/chi/librarydetail.php3?ID=41


·

National: Consumer Health Library Directory (Medical Library Association, Consumer and Patient Health Information Section), http://caphis.mlanet.org/directory/index.html

·

National: National Network of Libraries of Medicine (National Library of Medicine) - provides library services for health professionals in the United States who do not have access to a medical library, http://nnlm.gov/

·

National: NN/LM List of Libraries Serving the Public (National Network of Libraries of Medicine), http://nnlm.gov/members/

·

Nevada: Health Science Library, West Charleston Library (Las Vegas Clark County Library District), http://www.lvccld.org/special_collections/medical/index.htm

·

New Hampshire: Dartmouth Biomedical Libraries (Dartmouth College Library), http://www.dartmouth.edu/~biomed/resources.htmld/conshealth.htmld/

·

New Jersey: Consumer Health Library (Rahway Hospital), http://www.rahwayhospital.com/library.htm

·

New Jersey: Dr. Walter Phillips Health Sciences Library (Englewood Hospital and Medical Center), http://www.englewoodhospital.com/links/index.htm

·

New Jersey: Meland Foundation (Englewood Hospital and Medical Center), http://www.geocities.com/ResearchTriangle/9360/

·

New York: Choices in Health Information (New York Public Library) NLM Consumer Pilot Project participant, http://www.nypl.org/branch/health/links.html

·

New York: Health Information Center (Upstate Medical University, State University of New York), http://www.upstate.edu/library/hic/

·

New York: Health Sciences Library (Long Island Jewish Medical Center), http://www.lij.edu/library/library.html

·

New York: ViaHealth Medical Library (Rochester General Hospital), http://www.nyam.org/library/

·

Ohio: Consumer Health Library (Akron General Medical Center, Medical & Consumer Health Library), http://www.akrongeneral.org/hwlibrary.htm

·

Oklahoma: Saint Francis Health System Patient/Family Resource Center (Saint Francis Health System), http://www.sfhtulsa.com/patientfamilycenter/default.asp


·

Oregon: Planetree Health Resource Center (Mid-Columbia Medical Center), http://www.mcmc.net/phrc/

·

Pennsylvania: Community Health Information Library (Milton S. Hershey Medical Center), http://www.hmc.psu.edu/commhealth/

·

Pennsylvania: Community Health Resource Library (Geisinger Medical Center), http://www.geisinger.edu/education/commlib.shtml

·

Pennsylvania: HealthInfo Library (Moses Taylor Hospital), http://www.mth.org/healthwellness.html

·

Pennsylvania: Hopwood Library (University of Pittsburgh, Health Sciences Library System), http://www.hsls.pitt.edu/chi/hhrcinfo.html

·

Pennsylvania: Koop Community Health Information Center (College of Physicians of Philadelphia), http://www.collphyphil.org/kooppg1.shtml

·

Pennsylvania: Learning Resources Center - Medical Library (Susquehanna Health System), http://www.shscares.org/services/lrc/index.asp

·

Pennsylvania: Medical Library (UPMC Health System), http://www.upmc.edu/passavant/library.htm

·

Quebec, Canada: Medical Library (Montreal General Hospital), http://ww2.mcgill.ca/mghlib/

·

South Dakota: Rapid City Regional Hospital - Health Information Center (Rapid City Regional Hospital, Health Information Center), http://www.rcrh.org/education/LibraryResourcesConsumers.htm

·

Texas: Houston HealthWays (Houston Academy of Medicine-Texas Medical Center Library), http://hhw.library.tmc.edu/

·

Texas: Matustik Family Resource Center (Cook Children’s Health Care System), http://www.cookchildrens.com/Matustik_Library.html

·

Washington: Community Health Library (Kittitas Valley Community Hospital), http://www.kvch.com/

·

Washington: Southwest Washington Medical Center Library (Southwest Washington Medical Center), http://www.swmedctr.com/Home/

Online Glossaries 173

APPENDIX E. YOUR RIGHTS AND INSURANCE Overview Any patient with binge eating disorder faces a series of issues related more to the healthcare industry than to the medical condition itself. This appendix covers two important topics in this regard: your rights and responsibilities as a patient, and how to get the most out of your medical insurance plan.

Your Rights as a Patient The President’s Advisory Commission on Consumer Protection and Quality in the Healthcare Industry has created the following summary of your rights as a patient.51 Information Disclosure Consumers have the right to receive accurate, easily understood information. Some consumers require assistance in making informed decisions about health plans, health professionals, and healthcare facilities. Such information includes: ·

Health plans. Covered benefits, cost-sharing, and procedures for resolving complaints, licensure, certification, and accreditation status, comparable measures of quality and consumer satisfaction, provider network composition, the procedures that govern access to specialists and emergency services, and care management information.

51Adapted

from Consumer Bill of Rights and Responsibilities: http://www.hcqualitycommission.gov/press/cbor.html#head1.


·

Health professionals. Education, board certification, and recertification, years of practice, experience performing certain procedures, and comparable measures of quality and consumer satisfaction.

·

Healthcare facilities. Experience in performing certain procedures and services, accreditation status, comparable measures of quality, worker, and consumer satisfaction, and procedures for resolving complaints.

·

Consumer assistance programs. Programs must be carefully structured to promote consumer confidence and to work cooperatively with health plans, providers, payers, and regulators. Desirable characteristics of such programs are sponsorship that ensures accountability to the interests of consumers and stable, adequate funding.

Choice of Providers and Plans Consumers have the right to a choice of healthcare providers that is sufficient to ensure access to appropriate high-quality healthcare. To ensure such choice, the Commission recommends the following: ·

Provider network adequacy. All health plan networks should provide access to sufficient numbers and types of providers to assure that all covered services will be accessible without unreasonable delay -including access to emergency services 24 hours a day and 7 days a week. If a health plan has an insufficient number or type of providers to provide a covered benefit with the appropriate degree of specialization, the plan should ensure that the consumer obtains the benefit outside the network at no greater cost than if the benefit were obtained from participating providers.

·

Women’s health services. Women should be able to choose a qualified provider offered by a plan -- such as gynecologists, certified nurse midwives, and other qualified healthcare providers -- for the provision of covered care necessary to provide routine and preventative women’s healthcare services.

·

Access to specialists. Consumers with complex or serious medical conditions who require frequent specialty care should have direct access to a qualified specialist of their choice within a plan’s network of providers. Authorizations, when required, should be for an adequate number of direct access visits under an approved treatment plan.

·

Transitional care. Consumers who are undergoing a course of treatment for a chronic or disabling condition (or who are in the second or third trimester of a pregnancy) at the time they involuntarily change health


plans or at a time when a provider is terminated by a plan for other than cause should be able to continue seeing their current specialty providers for up to 90 days (or through completion of postpartum care) to allow for transition of care. ·

Choice of health plans. Public and private group purchasers should, wherever feasible, offer consumers a choice of high-quality health insurance plans.

Access to Emergency Services Consumers have the right to access emergency healthcare services when and where the need arises. Health plans should provide payment when a consumer presents to an emergency department with acute symptoms of sufficient severity--including severe pain--such that a “prudent layperson” could reasonably expect the absence of medical attention to result in placing that consumer’s health in serious jeopardy, serious impairment to bodily functions, or serious dysfunction of any bodily organ or part.

Participation in Treatment Decisions Consumers have the right and responsibility to fully participate in all decisions related to their healthcare. Consumers who are unable to fully participate in treatment decisions have the right to be represented by parents, guardians, family members, or other conservators. Physicians and other health professionals should: ·

Provide patients with sufficient information and opportunity to decide among treatment options consistent with the informed consent process.

·

Discuss all treatment options with a patient in a culturally competent manner, including the option of no treatment at all.

·

Ensure that persons with disabilities have effective communications with members of the health system in making such decisions.

·

Discuss all current treatments a consumer may be undergoing.

·

Discuss all risks, nontreatment.

·

Give patients the opportunity to refuse treatment and to express preferences about future treatment decisions.

benefits,

and

consequences

to

treatment

or


·

Discuss the use of advance directives -- both living wills and durable powers of attorney for healthcare -- with patients and their designated family members.

·

Abide by the decisions made by their patients and/or their designated representatives consistent with the informed consent process.

Health plans, health providers, and healthcare facilities should: ·

Disclose to consumers factors -- such as methods of compensation, ownership of or interest in healthcare facilities, or matters of conscience -that could influence advice or treatment decisions.

·

Assure that provider contracts do not contain any so-called “gag clauses” or other contractual mechanisms that restrict healthcare providers’ ability to communicate with and advise patients about medically necessary treatment options.

·

Be prohibited from penalizing or seeking retribution against healthcare professionals or other health workers for advocating on behalf of their patients.

Respect and Nondiscrimination Consumers have the right to considerate, respectful care from all members of the healthcare industry at all times and under all circumstances. An environment of mutual respect is essential to maintain a quality healthcare system. To assure that right, the Commission recommends the following: ·

Consumers must not be discriminated against in the delivery of healthcare services consistent with the benefits covered in their policy, or as required by law, based on race, ethnicity, national origin, religion, sex, age, mental or physical disability, sexual orientation, genetic information, or source of payment.

·

Consumers eligible for coverage under the terms and conditions of a health plan or program, or as required by law, must not be discriminated against in marketing and enrollment practices based on race, ethnicity, national origin, religion, sex, age, mental or physical disability, sexual orientation, genetic information, or source of payment. Confidentiality of Health Information

Consumers have the right to communicate with healthcare providers in confidence and to have the confidentiality of their individually identifiable


healthcare information protected. Consumers also have the right to review and copy their own medical records and request amendments to their records. Complaints and Appeals Consumers have the right to a fair and efficient process for resolving differences with their health plans, healthcare providers, and the institutions that serve them, including a rigorous system of internal review and an independent system of external review. A free copy of the Patient’s Bill of Rights is available from the American Hospital Association.52

Patient Responsibilities Treatment is a two-way street between you and your healthcare providers. To underscore the importance of finance in modern healthcare as well as your responsibility for the financial aspects of your care, the President’s Advisory Commission on Consumer Protection and Quality in the Healthcare Industry has proposed that patients understand the following “Consumer Responsibilities.”53 In a healthcare system that protects consumers’ rights, it is reasonable to expect and encourage consumers to assume certain responsibilities. Greater individual involvement by the consumer in his or her care increases the likelihood of achieving the best outcome and helps support a quality-oriented, cost-conscious environment. Such responsibilities include: ·

Take responsibility for maximizing healthy habits such as exercising, not smoking, and eating a healthy diet.

·

Work collaboratively with healthcare providers in developing and carrying out agreed-upon treatment plans.

·

Disclose relevant information and clearly communicate wants and needs.

·

Use your health insurance plan’s internal complaint and appeal processes to address your concerns.

·

Avoid knowingly spreading disease.

To order your free copy of the Patient’s Bill of Rights, telephone 312-422-3000 or visit the American Hospital Association’s Web site: http://www.aha.org. Click on “Resource Center,” go to “Search” at bottom of page, and then type in “Patient’s Bill of Rights.” The Patient’s Bill of Rights is also available from Fax on Demand, at 312-422-2020, document number 471124. 53 Adapted from http://www.hcqualitycommission.gov/press/cbor.html#head1. 52


·

Recognize the reality of risks, the limits of the medical science, and the human fallibility of the healthcare professional.

·

Be aware of a healthcare provider’s obligation to be reasonably efficient and equitable in providing care to other patients and the community.

·

Become knowledgeable about your health plan’s coverage and options (when available) including all covered benefits, limitations, and exclusions, rules regarding use of network providers, coverage and referral rules, appropriate processes to secure additional information, and the process to appeal coverage decisions.

·

Show respect for other patients and health workers.

·

Make a good-faith effort to meet financial obligations.

·

Abide by administrative and operational procedures of health plans, healthcare providers, and Government health benefit programs.

Choosing an Insurance Plan There are a number of official government agencies that help consumers understand their healthcare insurance choices.54 The U.S. Department of Labor, in particular, recommends ten ways to make your health benefits choices work best for you.55 1. Your options are important. There are many different types of health benefit plans. Find out which one your employer offers, then check out the plan, or plans, offered. Your employer’s human resource office, the health plan administrator, or your union can provide information to help you match your needs and preferences with the available plans. The more information you have, the better your healthcare decisions will be. 2. Reviewing the benefits available. Do the plans offered cover preventive care, well-baby care, vision or dental care? Are there deductibles? Answers to these questions can help determine the out-of-pocket expenses you may face. Matching your needs and those of your family members will result in the best possible benefits. Cheapest may not always be best. Your goal is high quality health benefits.

54 More information about quality across programs is provided at the following AHRQ Web site: http://www.ahrq.gov/consumer/qntascii/qnthplan.htm. 55 Adapted from the Department of Labor: http://www.dol.gov/dol/pwba/public/pubs/health/top10-text.html.


3. Look for quality. The quality of healthcare services varies, but quality can be measured. You should consider the quality of healthcare in deciding among the healthcare plans or options available to you. Not all health plans, doctors, hospitals and other providers give the highest quality care. Fortunately, there is quality information you can use right now to help you compare your healthcare choices. Find out how you can measure quality. Consult the U.S. Department of Health and Human Services publication “Your Guide to Choosing Quality Health Care” on the Internet at www.ahcpr.gov/consumer. 4. Your plan’s summary plan description (SPD) provides a wealth of information. Your health plan administrator can provide you with a copy of your plan’s SPD. It outlines your benefits and your legal rights under the Employee Retirement Income Security Act (ERISA), the federal law that protects your health benefits. It should contain information about the coverage of dependents, what services will require a co-pay, and the circumstances under which your employer can change or terminate a health benefits plan. Save the SPD and all other health plan brochures and documents, along with memos or correspondence from your employer relating to health benefits. 5. Assess your benefit coverage as your family status changes. Marriage, divorce, childbirth or adoption, and the death of a spouse are all life events that may signal a need to change your health benefits. You, your spouse and dependent children may be eligible for a special enrollment period under provisions of the Health Insurance Portability and Accountability Act (HIPAA). Even without life-changing events, the information provided by your employer should tell you how you can change benefits or switch plans, if more than one plan is offered. If your spouse’s employer also offers a health benefits package, consider coordinating both plans for maximum coverage. 6. Changing jobs and other life events can affect your health benefits. Under the Consolidated Omnibus Budget Reconciliation Act (COBRA), you, your covered spouse, and your dependent children may be eligible to purchase extended health coverage under your employer’s plan if you lose your job, change employers, get divorced, or upon occurrence of certain other events. Coverage can range from 18 to 36 months depending on your situation. COBRA applies to most employers with 20 or more workers and requires your plan to notify you of your rights. Most plans require eligible individuals to make their COBRA election within 60 days of the plan’s notice. Be sure to follow up with your plan sponsor if you don’t receive notice, and make sure you respond within the allotted time.


7. HIPAA can also help if you are changing jobs, particularly if you have a medical condition. HIPAA generally limits pre-existing condition exclusions to a maximum of 12 months (18 months for late enrollees). HIPAA also requires this maximum period to be reduced by the length of time you had prior “creditable coverage.” You should receive a certificate documenting your prior creditable coverage from your old plan when coverage ends. 8. Plan for retirement. Before you retire, find out what health benefits, if any, extend to you and your spouse during your retirement years. Consult with your employer’s human resources office, your union, the plan administrator, and check your SPD. Make sure there is no conflicting information among these sources about the benefits you will receive or the circumstances under which they can change or be eliminated. With this information in hand, you can make other important choices, like finding out if you are eligible for Medicare and Medigap insurance coverage. 9. Know how to file an appeal if your health benefits claim is denied. Understand how your plan handles grievances and where to make appeals of the plan’s decisions. Keep records and copies of correspondence. Check your health benefits package and your SPD to determine who is responsible for handling problems with benefit claims. Contact PWBA for customer service assistance if you are unable to obtain a response to your complaint. 10. You can take steps to improve the quality of the healthcare and the health benefits you receive. Look for and use things like Quality Reports and Accreditation Reports whenever you can. Quality reports may contain consumer ratings -- how satisfied consumers are with the doctors in their plan, for instance-- and clinical performance measures -- how well a healthcare organization prevents and treats illness. Accreditation reports provide information on how accredited organizations meet national standards, and often include clinical performance measures. Look for these quality measures whenever possible. Consult “Your Guide to Choosing Quality Health Care” on the Internet at www.ahcpr.gov/consumer.

Medicare and Medicaid Illness strikes both rich and poor families. For low-income families, Medicaid is available to defer the costs of treatment. The Health Care Financing Administration (HCFA) administers Medicare, the nation’s largest health insurance program, which covers 39 million Americans. In the following pages, you will learn the basics about Medicare insurance as well as useful


contact information on how to find more in-depth information about Medicaid.56

Who is Eligible for Medicare? Generally, you are eligible for Medicare if you or your spouse worked for at least 10 years in Medicare-covered employment and you are 65 years old and a citizen or permanent resident of the United States. You might also qualify for coverage if you are under age 65 but have a disability or EndStage Renal disease (permanent kidney failure requiring dialysis or transplant). Here are some simple guidelines: You can get Part A at age 65 without having to pay premiums if: ·

You are already receiving retirement benefits from Social Security or the Railroad Retirement Board.

·

You are eligible to receive Social Security or Railroad benefits but have not yet filed for them.

·

You or your spouse had Medicare-covered government employment.

If you are under 65, you can get Part A without having to pay premiums if: ·

You have received Social Security or Railroad Retirement Board disability benefit for 24 months.

·

You are a kidney dialysis or kidney transplant patient.

Medicare has two parts: ·

Part A (Hospital Insurance). Most people do not have to pay for Part A.

·

Part B (Medical Insurance). Most people pay monthly for Part B. Part A (Hospital Insurance)

Helps Pay For: Inpatient hospital care, care in critical access hospitals (small facilities that give limited outpatient and inpatient services to people in rural areas) and skilled nursing facilities, hospice care, and some home healthcare.

This section has been adapted from the Official U.S. Site for Medicare Information: http://www.medicare.gov/Basics/Overview.asp.

56


Cost: Most people get Part A automatically when they turn age 65. You do not have to pay a monthly payment called a premium for Part A because you or a spouse paid Medicare taxes while you were working. If you (or your spouse) did not pay Medicare taxes while you were working and you are age 65 or older, you still may be able to buy Part A. If you are not sure you have Part A, look on your red, white, and blue Medicare card. It will show “Hospital Part A” on the lower left corner of the card. You can also call the Social Security Administration toll free at 1-800-772-1213 or call your local Social Security office for more information about buying Part A. If you get benefits from the Railroad Retirement Board, call your local RRB office or 1-800-808-0772. For more information, call your Fiscal Intermediary about Part A bills and services. The phone number for the Fiscal Intermediary office in your area can be obtained from the following Web site: http://www.medicare.gov/Contacts/home.asp. Part B (Medical Insurance) Helps Pay For: Doctors, services, outpatient hospital care, and some other medical services that Part A does not cover, such as the services of physical and occupational therapists, and some home healthcare. Part B helps pay for covered services and supplies when they are medically necessary. Cost: As of 2001, you pay the Medicare Part B premium of $50.00 per month. In some cases this amount may be higher if you did not choose Part B when you first became eligible at age 65. The cost of Part B may go up 10% for each 12-month period that you were eligible for Part B but declined coverage, except in special cases. You will have to pay the extra 10% cost for the rest of your life. Enrolling in Part B is your choice. You can sign up for Part B anytime during a 7-month period that begins 3 months before you turn 65. Visit your local Social Security office, or call the Social Security Administration at 1-800-7721213 to sign up. If you choose to enroll in Part B, the premium is usually taken out of your monthly Social Security, Railroad Retirement, or Civil Service Retirement payment. If you do not receive any of the above payments, Medicare sends you a bill for your part B premium every 3 months. You should receive your Medicare premium bill in the mail by the 10th of the month. If you do not, call the Social Security Administration at 1800-772-1213, or your local Social Security office. If you get benefits from the Railroad Retirement Board, call your local RRB office or 1-800-808-0772. For more information, call your Medicare carrier about bills and services. The


phone number for the Medicare carrier in your area can be found at the following Web site: http://www.medicare.gov/Contacts/home.asp. You may have choices in how you get your healthcare including the Original Medicare Plan, Medicare Managed Care Plans (like HMOs), and Medicare Private Fee-for-Service Plans.

Medicaid Medicaid is a joint federal and state program that helps pay medical costs for some people with low incomes and limited resources. Medicaid programs vary from state to state. People on Medicaid may also get coverage for nursing home care and outpatient prescription drugs which are not covered by Medicare. You can find more information about Medicaid on the HCFA.gov Web site at http://www.hcfa.gov/medicaid/medicaid.htm. States also have programs that pay some or all of Medicare’s premiums and may also pay Medicare deductibles and coinsurance for certain people who have Medicare and a low income. To qualify, you must have: ·

Part A (Hospital Insurance),

·

Assets, such as bank accounts, stocks, and bonds that are not more than $4,000 for a single person, or $6,000 for a couple, and

·

A monthly income that is below certain limits.

For more information on these programs, look at the Medicare Savings Programs brochure, http://www.medicare.gov/Library/PDFNavigation/PDFInterim.asp?Langua ge=English&Type=Pub&PubID=10126. There are also Prescription Drug Assistance Programs available. Find information on these programs which offer discounts or free medications to individuals in need at http://www.medicare.gov/Prescription/Home.asp.

NORD’s Medication Assistance Programs Finally, the National Organization for Rare Disorders, Inc. (NORD) administers medication programs sponsored by humanitarian-minded pharmaceutical and biotechnology companies to help uninsured or underinsured individuals secure life-saving or life-sustaining drugs.57 NORD Adapted from NORD: http://www.rarediseases.org/cgibin/nord/progserv#patient?id=rPIzL9oD&mv_pc=30.

57


programs ensure that certain vital drugs are available “to those individuals whose income is too high to qualify for Medicaid but too low to pay for their prescribed medications.” The program has standards for fairness, equity, and unbiased eligibility. It currently covers some 14 programs for nine pharmaceutical companies. NORD also offers early access programs for investigational new drugs (IND) under the approved “Treatment INDs” programs of the Food and Drug Administration (FDA). In these programs, a limited number of individuals can receive investigational drugs that have yet to be approved by the FDA. These programs are generally designed for rare diseases or disorders. For more information, visit www.rarediseases.org.

Additional Resources In addition to the references already listed in this chapter, you may need more information on health insurance, hospitals, or the healthcare system in general. The NIH has set up an excellent guidance Web site that addresses these and other issues. Topics include:58 ·

Health Insurance: http://www.nlm.nih.gov/medlineplus/healthinsurance.html

·

Health Statistics: http://www.nlm.nih.gov/medlineplus/healthstatistics.html

·

HMO and Managed Care: http://www.nlm.nih.gov/medlineplus/managedcare.html

·

Hospice Care: http://www.nlm.nih.gov/medlineplus/hospicecare.html

·

Medicaid: http://www.nlm.nih.gov/medlineplus/medicaid.html

·

Medicare: http://www.nlm.nih.gov/medlineplus/medicare.html

·

Nursing Homes and Long-term Care: http://www.nlm.nih.gov/medlineplus/nursinghomes.html

·

Patient’s Rights, Confidentiality, Informed Consent, Ombudsman Programs, Privacy and Patient Issues: http://www.nlm.nih.gov/medlineplus/patientissues.html

You can access this information at: http://www.nlm.nih.gov/medlineplus/healthsystem.html.

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ONLINE GLOSSARIES The Internet provides access to a number of free-to-use medical dictionaries and glossaries. The National Library of Medicine has compiled the following list of online dictionaries: ·

ADAM Medical Encyclopedia (A.D.A.M., Inc.), comprehensive medical reference: http://www.nlm.nih.gov/medlineplus/encyclopedia.html

·

MedicineNet.com Medical Dictionary (MedicineNet, Inc.): http://www.medterms.com/Script/Main/hp.asp

·

Merriam-Webster Medical Dictionary (Inteli-Health, Inc.): http://www.intelihealth.com/IH/

·

Multilingual Glossary of Technical and Popular Medical Terms in Eight European Languages (European Commission) - Danish, Dutch, English, French, German, Italian, Portuguese, and Spanish: http://allserv.rug.ac.be/~rvdstich/eugloss/welcome.html

·

On-line Medical Dictionary (CancerWEB): http://www.graylab.ac.uk/omd/

·

Technology Glossary (National Library of Medicine) - Health Care Technology: http://www.nlm.nih.gov/nichsr/ta101/ta10108.htm

·

Terms and Definitions (Office of Rare Diseases): http://rarediseases.info.nih.gov/ord/glossary_a-e.html

Beyond these, MEDLINEplus contains a very user-friendly encyclopedia covering every aspect of medicine (licensed from A.D.A.M., Inc.). The ADAM Medical Encyclopedia Web site address is http://www.nlm.nih.gov/medlineplus/encyclopedia.html. ADAM is also available on commercial Web sites such as Web MD (http://my.webmd.com/adam/asset/adam_disease_articles/a_to_z/a) and drkoop.com (http://www.drkoop.com/). Topics of interest can be researched by using keywords before continuing elsewhere, as these basic definitions and concepts will be useful in more advanced areas of research. You may choose to print various pages specifically relating to binge eating disorder and keep them on file. The NIH, in particular, suggests that patients with binge eating disorder visit the following Web site in the ADAM Medical Encyclopedia:


·

Basic Guidelines for Binge Eating Disorder Eating disorders - resources Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002171.htm

Online Dictionary Directories The following are additional online directories compiled by the National Library of Medicine, including a number of specialized medical dictionaries and glossaries: ·

Medical Dictionaries: Medical & Biological (World Health Organization): http://www.who.int/hlt/virtuallibrary/English/diction.htm#Medical

·

MEL-Michigan Electronic Library List of Online Health and Medical Dictionaries (Michigan Electronic Library): http://mel.lib.mi.us/health/health-dictionaries.html

·

Patient Education: Glossaries (DMOZ Open Directory Project): http://dmoz.org/Health/Education/Patient_Education/Glossaries/

·

Web of Online Dictionaries (Bucknell University): http://www.yourdictionary.com/diction5.html#medicine

Glossary 187

BINGE EATING DISORDER GLOSSARY The following is a complete glossary of terms used in this sourcebook. The definitions are derived from official public sources including the National Institutes of Health [NIH] and the European Union [EU]. After this glossary, we list a number of additional hardbound and electronic glossaries and dictionaries that you may wish to consult. Abrasion: 1. the wearing away of a substance or structure (such as the skin or the teeth) through some unusual or abnormal mechanical process. 2. an area of body surface denuded of skin or mucous membrane by some unusual or abnormal mechanical process. [EU] Adolescence: The period of life beginning with the appearance of secondary sex characteristics and terminating with the cessation of somatic growth. The years usually referred to as adolescence lie between 13 and 18 years of age. [NIH]

Agonist: In anatomy, a prime mover. In pharmacology, a drug that has affinity for and stimulates physiologic activity at cell receptors normally stimulated by naturally occurring substances. [EU] Alkalosis: A pathologic condition resulting from accumulation of base, or from loss of acid without comparable loss of base in the body fluids, and characterized by decrease in hydrogen ion concentration (increase in pH). [EU]

Amenorrhea: amenia. [EU]

Absence or abnormal stoppage of the menses; called also

Anemia: A reduction in the number of circulating erythrocytes or in the quantity of hemoglobin. [NIH] Anorexia: Lack or loss of the appetite for food. [EU] Antidepressant: An agent that stimulates the mood of a depressed patient, including tricyclic antidepressants and monoamine oxidase inhibitors. [EU] Anxiety: The unpleasant emotional state consisting of psychophysiological responses to anticipation of unreal or imagined danger, ostensibly resulting from unrecognized intrapsychic conflict. Physiological concomitants include increased heart rate, altered respiration rate, sweating, trembling, weakness, and fatigue; psychological concomitants include feelings of impending danger, powerlessness, apprehension, and tension. [EU] Aspiration: The act of inhaling. [EU] Atypical: Irregular; not conformable to the type; in microbiology, applied specifically to strains of unusual type. [EU]


Bacteria: Unicellular prokaryotic microorganisms which generally possess rigid cell walls, multiply by cell division, and exhibit three principal forms: round or coccal, rodlike or bacillary, and spiral or spirochetal. [NIH] Beauty: Characteristics or attributes of persons or things which elicit pleasurable feelings. [NIH] Capsules: Hard or soft soluble containers used for the oral administration of medicine. [NIH] Carbohydrate: An aldehyde or ketone derivative of a polyhydric alcohol, particularly of the pentahydric and hexahydric alcohols. They are so named because the hydrogen and oxygen are usually in the proportion to form water, (CH2O)n. The most important carbohydrates are the starches, sugars, celluloses, and gums. They are classified into mono-, di-, tri-, poly- and heterosaccharides. [EU] Cardiac: Pertaining to the heart. [EU] Cardiovascular: Pertaining to the heart and blood vessels. [EU] Cerebral: Of or pertaining of the cerebrum or the brain. [EU] Cerebrospinal: Pertaining to the brain and spinal cord. [EU] Chemotherapy: The treatment of disease by means of chemicals that have a specific toxic effect upon the disease - producing microorganisms or that selectively destroy cancerous tissue. [EU] Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH] Chronic: Persisting over a long period of time. [EU] Colitis: Inflammation of the colon. [EU] Comorbidity: The presence of co-existing or additional diseases with reference to an initial diagnosis or with reference to the index condition that is the subject of study. Comorbidity may affect the ability of affected individuals to function and also their survival; it may be used as a prognostic indicator for length of hospital stay, cost factors, and outcome or survival. [NIH] Concomitant: Accompanying; accessory; joined with another. [EU] Constitutional: 1. affecting the whole constitution of the body; not local. 2. pertaining to the constitution. [EU] Cortex: The outer layer of an organ or other body structure, as distinguished from the internal substance. [EU] Cortical: Pertaining to or of the nature of a cortex or bark. [EU] Cues: Signals for an action; that specific portion of a perceptual field or pattern of stimuli to which a subject has learned to respond. [NIH]

Glossary 189

Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU] Dehydration: The condition that results from excessive loss of body water. Called also anhydration, deaquation and hypohydration. [EU] Dentists: Individuals licensed to practice dentistry. [NIH] Deprivation: Loss or absence of parts, organs, powers, or things that are needed. [EU] Diarrhea: Passage of excessively liquid or excessively frequent stools. [NIH] Diuresis: Increased excretion of urine. [EU] Dystonia: Disordered tonicity of muscle. [EU] Edema: Excessive amount of watery fluid accumulated in the intercellular spaces, most commonly present in subcutaneous tissue. [NIH] Electrolyte: A substance that dissociates into ions when fused or in solution, and thus becomes capable of conducting electricity; an ionic solute. [EU] Endocrinology: A subspecialty of internal medicine concerned with the metabolism, physiology, and disorders of the endocrine system. [NIH] Epidemiological: Relating to, or involving epidemiology. [EU] Esophagitis: Inflammation, acute or chronic, of the esophagus caused by bacteria, chemicals, or trauma. [NIH] Filtration: The passage of a liquid through a filter, accomplished by gravity, pressure, or vacuum (suction). [EU] Fluoxetine: The first highly specific serotonin uptake inhibitor. It is used as an antidepressant and often has a more acceptable side-effects profile than traditional antidepressants. [NIH] Gastrointestinal: Pertaining to or communicating with the stomach and intestine, as a gastrointestinal fistula. [EU] Glomerular: Pertaining to or of the nature of a glomerulus, especially a renal glomerulus. [EU] Glucose: D-glucose, a monosaccharide (hexose), C6H12O6, also known as dextrose (q.v.), found in certain foodstuffs, especially fruits, and in the normal blood of all animals. It is the end product of carbohydrate metabolism and is the chief source of energy for living organisms, its utilization being controlled by insulin. Excess glucose is converted to glycogen and stored in the liver and muscles for use as needed and, beyond that, is converted to fat and stored as adipose tissue. Glucose appears in the urine in diabetes mellitus. [EU] Hematology:

A subspecialty of internal medicine concerned with


morphology, physiology, and pathology of the blood and blood-forming tissues. [NIH] Hormonal: Pertaining to or of the nature of a hormone. [EU] Hunger: The desire for food generated by a sensation arising from the lack of food in the stomach. [NIH] Hyperlipidemia: An excess of lipids in the blood. [NIH] Hyperphagia: Ingestion of a greater than optimal quantity of food. [NIH] Hypersensitivity: A state of altered reactivity in which the body reacts with an exaggerated immune response to a foreign substance. Hypersensitivity reactions are classified as immediate or delayed, types I and IV, respectively, in the Gell and Coombs classification (q.v.) of immune responses. [EU] Ingestion: The act of taking food, medicines, etc., into the body, by mouth. [EU]

Inpatients: Persons admitted to health facilities which provide board and room, for the purpose of observation, care, diagnosis or treatment. [NIH] Insulin: A protein hormone secreted by beta cells of the pancreas. Insulin plays a major role in the regulation of glucose metabolism, generally promoting the cellular utilization of glucose. It is also an important regulator of protein and lipid metabolism. Insulin is used as a drug to control insulindependent diabetes mellitus. [NIH] Interstitial: Pertaining to or situated between parts or in the interspaces of a tissue. [EU] Invasive: 1. having the quality of invasiveness. 2. involving puncture or incision of the skin or insertion of an instrument or foreign material into the body; said of diagnostic techniques. [EU] Iodine: A nonmetallic element of the halogen group that is represented by the atomic symbol I, atomic number 53, and atomic weight of 126.90. It is a nutritionally essential element, especially important in thyroid hormone synthesis. In solution, it has anti-infective properties and is used topically. [NIH]

Ketoacidosis: Acidosis accompanied by the accumulation of ketone bodies (ketosis) in the body tissues and fluids, as in diabetic acidosis. [EU] Kinetic: Pertaining to or producing motion. [EU] Laceration: 1. the act of tearing. 2. a torn, ragged, mangled wound. [EU] LH: A small glycoprotein hormone secreted by the anterior pituitary. LH plays an important role in controlling ovulation and in controlling secretion of hormones by the ovaries and testes. [NIH] Lipid: Any of a heterogeneous group of flats and fatlike substances characterized by being water-insoluble and being extractable by nonpolar (or

Glossary 191

fat) solvents such as alcohol, ether, chloroform, benzene, etc. All contain as a major constituent aliphatic hydrocarbons. The lipids, which are easily stored in the body, serve as a source of fuel, are an important constituent of cell structure, and serve other biological functions. Lipids may be considered to include fatty acids, neutral fats, waxes, and steroids. Compound lipids comprise the glycolipids, lipoproteins, and phospholipids. [EU] Membrane: A thin layer of tissue which covers a surface, lines a cavity or divides a space or organ. [EU] Mental: Pertaining to the mind; psychic. 2. (L. mentum chin) pertaining to the chin. [EU] Metabolite: process. [EU]

Any substance produced by metabolism or by a metabolic

Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Mucosa: A mucous membrane, or tunica mucosa. [EU] Naltrexone: Derivative of noroxymorphone that is the N-cyclopropylmethyl congener of naloxone. It is a narcotic antagonist that is effective orally, longer lasting and more potent than naloxone, and has been proposed for the treatment of heroin addiction. The FDA has approved naltrexone for the treatment of alcohol dependence. [NIH] Nausea: An unpleasant sensation, vaguely referred to the epigastrium and abdomen, and often culminating in vomiting. [EU] Necrosis: The sum of the morphological changes indicative of cell death and caused by the progressive degradative action of enzymes; it may affect groups of cells or part of a structure or an organ. [EU] Nephropathy: Disease of the kidneys. [EU] Neural: 1. pertaining to a nerve or to the nerves. 2. situated in the region of the spinal axis, as the neutral arch. [EU] Niacin: Water-soluble vitamin of the B complex occurring in various animal and plant tissues. Required by the body for the formation of coenzymes NAD and NADP. Has pellagra-curative, vasodilating, and antilipemic properties. [NIH] Nitrogen: An element with the atomic symbol N, atomic number 7, and atomic weight 14. Nitrogen exists as a diatomic gas and makes up about 78% of the earth's atmosphere by volume. It is a constituent of proteins and nucleic acids and found in all living cells. [NIH] Obsession: A recurrent, persistent thought, image, or impulse that is unwanted and distressing (ego-dystonic) and comes involuntarily to mind despite attempts to ignore or suppress it. Common obsessions involve


thoughts of violence, contamination, and self-doubt. [EU] Osteoporosis: Reduction in the amount of bone mass, leading to fractures after minimal trauma. [EU] Outpatients: Persons who receive ambulatory care at an outpatient department or clinic without room and board being provided. [NIH] Overdose: 1. to administer an excessive dose. 2. an excessive dose. [EU] Pediatrics: A medical specialty concerned with maintaining health and providing medical care to children from birth to adolescence. [NIH] Pharmacists: Those persons legally qualified by education and training to engage in the practice of pharmacy. [NIH] Pharmacologic: Pertaining to pharmacology or to the properties and reactions of drugs. [EU] Phentermine: A central nervous system stimulant and sympathomimetic with actions and uses similar to those of dextroamphetamine. It has been used most frequently in the treatment of obesity. [NIH] Pneumonia: Inflammation of the lungs with consolidation. [EU] Potassium: An element that is in the alkali group of metals. It has an atomic symbol K, atomic number 19, and atomic weight 39.10. It is the chief cation in the intracellular fluid of muscle and other cells. Potassium ion is a strong electrolyte and it plays a significant role in the regulation of fluid volume and maintenance of the water-electrolyte balance. [NIH] Predisposition: A latent susceptibility to disease which may be activated under certain conditions, as by stress. [EU] Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH]

Psychiatric: Pertaining to or within the purview of psychiatry. [EU] Psychiatry: The medical science that deals with the origin, diagnosis, prevention, and treatment of mental disorders. [NIH] Psychology: The science dealing with the study of mental processes and behavior in man and animals. [NIH] Psychopathology: The study of significant causes and processes in the development of mental illness. [NIH] Psychopharmacology: The study of the effects of drugs on mental and behavioral activity. [NIH] Psychosomatic: Pertaining to the mind-body relationship; having bodily symptoms of psychic, emotional, or mental origin; called also psychophysiologic. [EU]

Glossary 193

Psychotherapy: A generic term for the treatment of mental illness or emotional disturbances primarily by verbal or nonverbal communication. [NIH]

Pulse: The rhythmical expansion and contraction of an artery produced by waves of pressure caused by the ejection of blood from the left ventricle of the heart as it contracts. [NIH] Punishment: The application of an unpleasant stimulus or penalty for the purpose of eliminating or correcting undesirable behavior. [NIH] Receptor: 1. a molecular structure within a cell or on the surface characterized by (1) selective binding of a specific substance and (2) a specific physiologic effect that accompanies the binding, e.g., cell-surface receptors for peptide hormones, neurotransmitters, antigens, complement fragments, and immunoglobulins and cytoplasmic receptors for steroid hormones. 2. a sensory nerve terminal that responds to stimuli of various kinds. [EU] Rectal: Pertaining to the rectum (= distal portion of the large intestine). [EU] Regurgitation: A backward flowing, as the casting up of undigested food, or the backward flowing of blood into the heart, or between the chambers of the heart when a valve is incompetent. [EU] Riboflavin: Nutritional factor found in milk, eggs, malted barley, liver, kidney, heart, and leafy vegetables. The richest natural source is yeast. It occurs in the free form only in the retina of the eye, in whey, and in urine; its principal forms in tissues and cells are as FMN and FAD. [NIH] Secretion: 1. the process of elaborating a specific product as a result of the activity of a gland; this activity may range from separating a specific substance of the blood to the elaboration of a new chemical substance. 2. any substance produced by secretion. [EU] Selenium: An element with the atomic symbol Se, atomic number 34, and atomic weight 78.96. It is an essential micronutrient for mammals and other animals but is toxic in large amounts. Selenium protects intracellular structures against oxidative damage. It is an essential component of glutathione peroxidase. [NIH] Spectrum: A charted band of wavelengths of electromagnetic vibrations obtained by refraction and diffraction. By extension, a measurable range of activity, such as the range of bacteria affected by an antibiotic (antibacterial s.) or the complete range of manifestations of a disease. [EU] Subclinical: Without clinical manifestations; said of the early stage(s) of an infection or other disease or abnormality before symptoms and signs become apparent or detectable by clinical examination or laboratory tests, or of a very mild form of an infection or other disease or abnormality. [EU]


Suicide: The act of killing oneself. [NIH] Systemic: Pertaining to or affecting the body as a whole. [EU] Thermoregulation: Heat regulation. [EU] Thinness: A state of insufficient flesh on the body usually defined as having a body weight less than skeletal and physical standards. [NIH] Thrombocytopenia: Decrease in the number of blood platelets. [EU] Thyroxine: An amino acid of the thyroid gland which exerts a stimulating effect on thyroid metabolism. [NIH] Topical: Pertaining to a particular surface area, as a topical anti-infective applied to a certain area of the skin and affecting only the area to which it is applied. [EU] Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] Trichotillomania: Compulsion to pull out one's hair. [NIH] Ulcer: A local defect, or excavation, of the surface of an organ or tissue; which is produced by the sloughing of inflammatory necrotic tissue. [EU] Urology: A surgical specialty concerned with the study, diagnosis, and treatment of diseases of the urinary tract in both sexes and the genital tract in the male. It includes the specialty of andrology which addresses both male genital diseases and male infertility. [NIH] Vaccination: The introduction of vaccine into the body for the purpose of inducing immunity. Coined originally to apply to the injection of smallpox vaccine, the term has come to mean any immunizing procedure in which vaccine is injected. [EU] Veterinarians: Individuals with a degree in veterinary medicine that provides them with training and qualifications to treat diseases and injuries of animals. [NIH] Withdrawal: 1. a pathological retreat from interpersonal contact and social involvement, as may occur in schizophrenia, depression, or schizoid avoidant and schizotypal personality disorders. 2. (DSM III-R) a substancespecific organic brain syndrome that follows the cessation of use or reduction in intake of a psychoactive substance that had been regularly used to induce a state of intoxication. [EU]

Glossary 195

General Dictionaries and Glossaries While the above glossary is essentially complete, the dictionaries listed here cover virtually all aspects of medicine, from basic words and phrases to more advanced terms (sorted alphabetically by title; hyperlinks provide rankings, information and reviews at Amazon.com): ·

Dictionary of Medical Acronymns & Abbreviations by Stanley Jablonski (Editor), Paperback, 4th edition (2001), Lippincott Williams & Wilkins Publishers, ISBN: 1560534605, http://www.amazon.com/exec/obidos/ASIN/1560534605/icongroupinterna

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Dictionary of Medical Terms : For the Nonmedical Person (Dictionary of Medical Terms for the Nonmedical Person, Ed 4) by Mikel A. Rothenberg, M.D, et al, Paperback - 544 pages, 4th edition (2000), Barrons Educational Series, ISBN: 0764112015, http://www.amazon.com/exec/obidos/ASIN/0764112015/icongroupinterna

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A Dictionary of the History of Medicine by A. Sebastian, CD-Rom edition (2001), CRC Press-Parthenon Publishers, ISBN: 185070368X, http://www.amazon.com/exec/obidos/ASIN/185070368X/icongroupinterna

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Dorland’s Illustrated Medical Dictionary (Standard Version) by Dorland, et al, Hardcover - 2088 pages, 29th edition (2000), W B Saunders Co, ISBN: 0721662544, http://www.amazon.com/exec/obidos/ASIN/0721662544/icongroupinterna

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Dorland’s Electronic Medical Dictionary by Dorland, et al, Software, 29th Book & CD-Rom edition (2000), Harcourt Health Sciences, ISBN: 0721694934, http://www.amazon.com/exec/obidos/ASIN/0721694934/icongroupinterna

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Dorland’s Pocket Medical Dictionary (Dorland’s Pocket Medical Dictionary, 26th Ed) Hardcover - 912 pages, 26th edition (2001), W B Saunders Co, ISBN: 0721682812, http://www.amazon.com/exec/obidos/ASIN/0721682812/icongroupinterna/ 103-4193558-7304618

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Melloni’s Illustrated Medical Dictionary (Melloni’s Illustrated Medical Dictionary, 4th Ed) by Melloni, Hardcover, 4th edition (2001), CRC PressParthenon Publishers, ISBN: 85070094X, http://www.amazon.com/exec/obidos/ASIN/85070094X/icongroupinterna

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Stedman’s Electronic Medical Dictionary Version 5.0 (CD-ROM for Windows and Macintosh, Individual) by Stedmans, CD-ROM edition (2000), Lippincott Williams & Wilkins Publishers, ISBN: 0781726328, http://www.amazon.com/exec/obidos/ASIN/0781726328/icongroupinterna

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Stedman’s Medical Dictionary by Thomas Lathrop Stedman, Hardcover 2098 pages, 27th edition (2000), Lippincott, Williams & Wilkins, ISBN:


068340007X, http://www.amazon.com/exec/obidos/ASIN/068340007X/icongroupinterna ·

Tabers Cyclopedic Medical Dictionary (Thumb Index) by Donald Venes (Editor), et al, Hardcover - 2439 pages, 19th edition (2001), F A Davis Co, ISBN: 0803606540, http://www.amazon.com/exec/obidos/ASIN/0803606540/icongroupinterna

Index 197

INDEX A Adolescence ........53, 61, 70, 72, 187, 192 Agonist...................................................65 Alkalosis ..............................................103 Amenorrhea.....................................53, 74 Anemia ......................................51, 53, 87 Anorexia .....20, 21, 26, 51, 52, 53, 54, 67, 74, 77, 83, 84, 85, 87, 92, 95, 102, 103, 112, 144, 159 Antidepressant.......37, 43, 49, 60, 92, 189 Anxiety.............................................53, 59 Aspiration...............................................53 Atypical ..................................................61 B Bacteria ...................23, 70, 152, 189, 193 Beauty ...................................................26 C Capsules..............................................155 Carbohydrate.............64, 65, 71, 154, 189 Cardiac ..................................................21 Cardiovascular.................................53, 87 Cerebrospinal ......................................143 Chemotherapy .....................................102 Cholesterol ............................13, 152, 154 Chronic ..............58, 66, 70, 103, 174, 189 Colitis .....................................................20 Comorbidity ...........................................87 Concomitant ..........................................63 Constitutional.........................................63 Cortex ............................................43, 188 Cues ........................................55, 63, 142 D Degenerative .......................................153 Dehydration ...........................................87 Dentists............................................26, 50 Deprivation ..........................................142 Diarrhea...............................................152 Diuresis................................................103 E Electrolyte................53, 87, 103, 163, 192 Endocrinology........................................30 Epidemiological .....................................61 Esophagitis ............................................50 F Filtration.................................................87 Fluoxetine ..................................37, 60, 98 G Gastrointestinal..................49, 53, 70, 189 Glomerular.............................................87 Glucose .........51, 59, 70, 71, 88, 189, 190

H Hematology........................................... 10 Hormonal .............................................. 51 Hunger ................................ 53, 55, 64, 95 Hyperlipidemia ...................................... 74 Hyperphagia ......................................... 67 I Ingestion ................................. 50, 66, 155 Inpatients ............................................ 141 Insulin........................ 51, 71, 88, 189, 190 Interstitial............................................. 103 K Ketoacidosis ......................................... 51 L Lipid ........................................ 59, 71, 190 M Membrane....................... 69, 71, 187, 191 Mental .. 23, 52, 53, 66, 72, 133, 136, 176, 192, 193 Metabolite ........................................... 155 Molecular ................ 10, 72, 110, 114, 193 Mucosa ................................... 50, 71, 191 N Naltrexone............................... 37, 43, 191 Nausea................................................ 102 Necrosis ................................................ 50 Nephropathy ......................................... 87 Niacin .................................................. 153 Nitrogen ................................................ 87 O Obsession ..................................... 95, 104 Outpatients............................................ 87 Overdose ............................................ 153 P Pharmacists .......................................... 26 Pharmacologic .................. 23, 61, 83, 194 Phentermine ......................................... 60 Pneumonia............................................ 53 Potassium ........................................... 154 Predisposition ..................................... 105 Prevalence . 49, 50, 51, 62, 63, 66, 67, 69, 75, 87, 88, 139 Progressive ................................... 71, 191 Prolapse.............................................. 103 Proteins......................... 90, 152, 154, 191 Psychiatric....... 48, 53, 57, 62, 63, 87, 141 Psychiatry ........................................... 192 Psychopathology .............. 59, 60, 61, 158 Psychopharmacology ........................... 17 Psychotherapy . 14, 49, 52, 57, 60, 66, 88, 101


Punishment..........................................104 R Receptor ................................................65 Rectal ..................................................103 Regurgitation ...................................50, 52 Riboflavin.............................................152 S Secretion ...................64, 71, 72, 190, 193 Selenium..............................................154 Skeletal ................................................194 Spectrum ...................................10, 63, 83 Subclinical ...............................63, 88, 157 Suicide ...................................................21 Systemic ................................................76

T Thermoregulation................................ 152 Thinness ................................... 51, 88, 95 Thrombocytopenia ................................ 87 Thyroxine ............................................ 154 Topical ........................................ 112, 194 Toxicology..................................... 10, 111 U Urology.................................................. 10 V Vomitus ................................................. 53 W Withdrawal ............................................ 53

Index 199


Index 201


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