Today we have the good fortune to hear from Dr. Kelly Klump whose contributions to the field of eating disorders are indeed invaluable. Inspired by one of her early mentors, Professor Gloria Leon, Dr. Klump has embarked on a journey of groundbreaking research that reshapes our understanding of the complex interplay between genetics, hormones, and environmental factors in the development of eating disorders. Dr. Klump’s exploration of gonadal hormones, including estrogen, progesterone, and testosterone, is steadily uncovering the relationship of hormonal fluctuations, particularly during puberty, to the onset and expression of eating disorders. Translating these findings to clinical practice has the potential to inform more effective prevention strategies and personalized interventions for individuals at risk of developing eating disorders.

In this episode, we delve into the insights of Trinity University Psychology Professor Carolyn Becker, whose insatiable curiosity and openness to explore diverse fields have been the driving forces behind her innovative and fruitful career. Recognized for her excellence in teaching and research, Professor Becker's expertise lies in implementing scientifically backed interventions in both clinical and real-world contexts. She has led innovative work focused on body image and athletes and has spearheaded groundbreaking research on eating disorders among individuals facing food insecurity, a demographic often overlooked by conventional eating disorder studies. Her work underscores the imperative to dismantle stereotypes surrounding eating disorders.

Today’s episode takes us on a global journey with Dr. Anne Becker, Maude and Lillian Presley Professor of Global Health and Social Medicine at Harvard Medical School. Although Anne never became the meteorologist she imagined in her youth, as a psychiatrist and anthropologist, she traveled far from home to launch pioneering work in Fiji focused on how culture contributes to shaping the meaning of body image and risk for eating disorders. In this episode, Anne shares how she got to Fiji, the surprising conversations, and the evolving meaning of weight in Fijian communities at different points in time. Anne shares the serendipitous circumstances that enabled her to map the impact of the arrival of American television on triggering eating disorder symptoms and rising body shape and weight concerns. Dr. Becker’s keen intellect and her delight in discovery is riveting and contagious as she shares her pioneering work, which is foundational for anyone who wants to understand culture and eating disorders. Becker, A.E. Television, Disordered Eating, and Young Women in Fiji: Negotiating Body Image and Identity during Rapid Social Change. Cult Med Psychiatry 28, 533–559 (2004). https://doi.org/10.1007/s11013-004-1067-5 Becker, A.E. Body, Self, and Society: The View from Fiji, 1995.

We are thrilled to be joined today by Dr. Paul Appelbaum for the last of episode in our special series focused on the proposed diagnosis of “terminal anorexia nervosa.” Dr. Appelbaum is the Elizabeth K Dollard Professor of Psychiatry, Medicine, and Law at Columbia University and Past President of the American Psychiatric Association, the American Academy of Psychiatry and the Law, and the Massachusetts Psychiatric Society. A member of the Institute of Medicine of the National Academy of Sciences, Dr. Applebaum has received numerous awards for his extraordinary contribution to forensic psychiatry, psychiatric aspects of jurisprudence, clinical trial ethics, capacity assessments, and medical aid in dying. Dr. Appelbaum brings a depth of experience and particular expertise to our discussion of “terminal anorexia nervosa” and the use medical aid in dying in psychiatry more broadly.

I am delighted to be joined today by Rachel Rattenni as part of our special series focused on the proposed diagnosis “terminal anorexia nervosa.” Rachel has a graduate degree in bioethics from Columbia University and is currently pursuing a master’s in public health at Johns Hopkins University Bloomberg School of Public Health.  She also serves as Rachel serves as the Program Assistant for Big Ideas In Eating Disorders. Her formal studies and work, in combination with her own lived experience with an eating disorder, inform her thoughtful and insightful comments on the risk of losing hope associated with the proposed diagnosis and the need to create more space for patients to have voice and agency in shaping their treatment goals, i.e., from the beginning and long before they meet the proposed criteria for “terminal anorexia nervosa.”

Today's episode of Big Ideas in Eating Disorders is part of a special series delving into the proposed diagnosis of "Terminal Anorexia Nervosa." I am honored to have Dr. Eric van Furth, a clinical psychologist and Professor of Eating Disorders in the Department of Psychiatry at Leiden University Medical Center, as our guest. With decades of experience in the eating disorder field, Dr. van Furth has received numerous awards and accolades, including a Leadership Award from the Academy for Eating Disorders and the Project HEAL Clinician of the Year Award.   Dr. Van Furth’s research has contributed extensively to increasing our understanding of effective treatments and improving treatment outcomes for people with anorexia nervosa. Hailing from the Netherlands, a country with universal healthcare and where Medical Aid in Dying (MAID) is available for individuals with psychiatric disorders, his unique perspective enriches our ongoing dialogue about anorexia nervosa, its terminology, and the current discussions surrounding the proposed diagnosis of “Terminal Anorexia Nervosa.”

The current episode is the third of our six-part series focused on the proposed diagnosis of “terminal anorexia nervosa.” My guest is Rosiel Elwyn (they/them/she), a PhD candidate at the Thompson Institute, Australia, who is studying the neurobiology of anorexia nervosa with a focus on the role of trauma and its effects on the glutamatergic system, the gut microbiome, and interoceptive function. Rosiel has lived with anorexia nervosa since childhood and currently works as a lived experience researcher and mental health consultant on a number of projects and advisory groups in eating disorders, suicide prevention, psychosis, trauma, and trauma-informed care, with a particular interest in co-design in these areas. With heart and mind, Rosiel shares with us hard earned insights on the proposed diagnosis of “terminal anorexia nervosa” and demonstrates brilliantly the unique and essential contributions that people with lived experience bring to field of eating disorders. Elwyn, R. A lived experience response to the proposed diagnosis of terminal anorexia nervosa: learning from iatrogenic harm, ambivalence and enduring hope. J Eat Disord 11, 2 (2023). https://doi.org/10.1186/s40337-022-00729-0 Treem, J., Yager, J., Guadiani, J.L. AMA J Ethics. 2023;25(9):E703-709. doi: 10.1001/amajethics.2023.703

Joining the podcast is Dr. Angela Guarda, the Stephen and Jean Robinson Professor of Eating Disorders in the Department of Psychiatry and Behavioral Sciences at the Johns Hopkins School of Medicine and Director of their Eating Disorders Program since 1997. This is the second episode in a six-part series that revolves around Guadiani, Bogetz, and Yager's suggested diagnosis of "Terminal Anorexia Nervosa." In our conversation, Dr. Guarda reflects on her decades of clinical and research expertise and provides a thoughtful and impassioned response to this complicated and provocative proposal. I have reflected many times on our conversation since its recording. Consummate educator, Dr. Guarda has much to teach us. Guarda AS, Hanson A, Mehler P, Westmoreland P. Terminal anorexia nervosa is a dangerous term: it cannot, and should not, be defined. J Eat Disord. 2022 Jun 7;10(1):79. doi: 10.1186/s40337-022-00599-6. Gaudiani, J.L., Bogetz, A. & Yager, J. Terminal anorexia nervosa: three cases and proposed clinical characteristics. J Eat Disord 10, 23 (2022). https://doi.org/10.1186/s40337-022-00548-3

This marks the beginning of a six-part series centered around the proposed diagnosis of "Terminal Anorexia Nervosa." In this inaugural episode, I talk with Dr. Joel Yager, Professor Emeritus of Psychiatry at the University of Colorado School of Medicine. Dr. Yager, alongside co-authors Dr. Jennifer Guadiani and Alyssa Bogetz, an individual with Anorexia Nervosa who passed away before the article's publication, proposed the criteria for “Terminal Anorexia Nervosa” in the paper linked below. With decades of experience in the eating disorder field, Dr. Yager served as the Director of the Eating Disorders Clinic at UCLA from 1981 to 1988. His contributions have earned him numerous awards, including the Lifetime Achievement Award from the National Eating Disorders Association, the Special Presidential Commendation, and the Distinguished Service Award from the American Psychiatric Association, along with a Lifetime Achievement Award from the Colorado Psychiatric Society. Drawing from his extensive expertise, Dr. Yager articulates why he believes it is crucial for the field to grapple with and refine the proposed diagnosis of "Terminal Anorexia Nervosa." This proposal has ignited a robust conversation and debate among a diverse range of stakeholders. In the upcoming episodes, we will hear perspectives from American and European colleagues, a biomedical ethicist, and individuals with lived experiences -  all sharing their varied views on this highly controversial topic. Gaudiani, J.L., Bogetz, A. & Yager, J. Terminal anorexia nervosa: three cases and proposed clinical characteristics. J Eat Disord 10, 23 (2022). https://doi.org/10.1186/s40337-022-00548-3 Be sure to subscribe so you do not miss additional episodes in this series as they are released over the coming weeks. Check out our website for more information: bigideasineatingdisorders.com

Join us for an episode with consummate eating disorders clinician, Judith Banker. As founder and Executive Director of the Center for Eating Disorders in Ann Arbor since 1983, Judy has a breadth of experience and a depth of wisdom that few therapists achieve in a lifetime. In this episode, she observes the rising rate of eating disorders across the age spectrum - with many younger and older individuals presenting for treatment compared to when she first began in the field. Judy reflects on the process of therapy, how the work has become more challenging and complex over the years, the rewards of the work, and the need for self-care, which she finds in music as a performing songwriter. This insightful conversation about psychotherapy and eating disorders is filled with tremendous expertise that is matched by warmth and compassion.

In this episode we hear from Dr. Bryn Austin, award-winning researcher, teacher, and mentor and Founding Director of the Strategic Training Initiative for the Prevention of Eating Disorders: A Public Health Incubator (STRIPED). Dr. Austin is Professor of Pediatrics at Harvard Medical School and Professor of Social and Behavioral Sciences at the Harvard T.H. Chan School of Public Health. In this episode, she urges all of us in the field to think about risk for eating disorders from a public health and social justice perspective. She has documented that the economic cost of eating disorders is close to 65 billion USD annually - on par with severe mental illnesses like schizophrenia. She has also led research that demonstrates that prevention interventions are cost-effective. She urges scientists to get involved with policy and democracy – to engage with the world to change the world. Specifically, she makes the case that we need to pursue policy strategies to combat toxic environmental factors like social media, weight discrimination, and predatory products (like diet pills) to raise awareness and make systems changes that reduce the risk for eating disorders at a population level. After listening to Dr. Austin, your understanding of eating disorders risk and prevention will be forever transformed.

Professor Kyle DeYoung started his university education with a focus on engineering and shifted pursuits when he decided to take a psychology elective and discovered his passion for the field. He reflects on the profound impact mentors can have in shaping our academic and professional careers and shares some really interesting ideas about the relationship of sleep and circadian rhythms to eating behaviors. Join us for this episode to learn more about a truly big idea in eating disorders.

In this episode, Dr. Pike is joined by Dr. Allan Kaplan who is University of Toronto Department of Psychiatry Professor and past Vice Dean for  Graduate and Academic Affairs in the Faculty of Medicine. Dr. Kaplan has served as President of both the Academy for Eating Disorders and the Eating Disorders Research Society. Reflecting decades of experience as a researcher, educator, and clinician, in this episode, Dr. Kaplan describes the abyss between the general public’s misunderstanding of eating disorders as volitional and self-inflicted and the reality of the experience for those with personal experience - and what the field needs to do to close this gap.

Dr. Pamela Keel is Distinguished Research Professor of Psychology at Florida State University. Dr. Keel has served as president of the Academy of Eating Disorders and the Eating Disorder Research Society and has contributed widely to the field of eating disorders. Here we discuss how Dr. Keel’s work on purging disorder stemmed from her earlier clinical work on bulimia nervosa and how our existing diagnostic system fails to describe the syndrome of purging that burdens a significant number of individuals.

Professor Yael Latzer is former Dean of the School of Social Work at the Faculty of Social Welfare and Health Sciences at Haifa University in Israel. She is also the founder and former director of the Eating Disorders Institution in the Psychiatric Division in Rambam, Health Care Campus. Dr. Latzer is also one of the founders of the Israeli Association for Eating Disorders and served for several years as its president. In this episode, Professor Latzer shares with us the innovative residential program that has been launched in Israel for women recovering from eating disorders. It is a model that can provide inspiration for eating disorder programs worldwide.

In this episode of Big Ideas In Eating Disorders, Dr. Jenny Thomas shares with us how her personal history as an aspiring ballerina put her at risk for developing an eating disorder, her good fortune in getting evidence-based therapy, and how this propelled her into becoming a pioneer in the study and treatment of ARFID. LINKS: https://www.massgeneral.org/assets/mgh/pdf/psychiatry/arfid%20r01%20ar%20flyer%208.18.22.pdf https://rally.massgeneralbrigham.org/study/project_feed_arfid

Dr. Michael J. Devlin is Professor of Clinical Psychiatry at Columbia University College of Physicians and Surgeons and where he is also a member of the Eating Disorders Research Unit at New York State Psychiatric Institute. He has served as President of the Academy for Eating Disorders and was a pioneer in the development of behavioral treatments for individuals with Binge Eating Disorder. In this episode, Dr. Devlin urges us to focus on the implications of the language we use, recognizing that our language shapes how we think, feel, and even how we behave – sometimes with good effect, but sometimes to very serious negative effect. He shares his personal experience as a gay man and his professional experience as a clinician and researcher with patients as he poignantly articulates the benefits for many people when Binge Eating Disorder was recognized as a real condition, the toxic effects of the term obesity, and the ominous risks associated with the term “terminal anorexia.” He eloquently reminds us to be curious, and to pay attention to how language has the potential to harm and heal.

Dr. Glenn Waller is a clinical psychologist and professor at the University of Sheffield, UK. He is a past-president of the Academy for Eating Disorders, and is currently president of the Eating Disorders Research Society. Dr. Waller has decades of experience as a clinical researcher evaluating and evolving cognitive behavioral treatments for individuals with eating disorders. In this episode, he challenges therapists to refrain from adopting what Paul Meehl called the “spun glass theory of mind” when treating patients. Instead he urges us to develop true therapeutic alliances that are not only compassionate, but also, brave. This episode is filled with clinical wisdom not to be missed.

Dr. Hans Hoek is clinical psychiatrist at the Eating Disorders Program in the Hague and Professor of Psychiatry at University of Groningen in the Netherlands. He also holds a faculty appointment at Columbia University in New York City. For many years, Dr. Hoek served as director of the psychiatric residency program and dean of Parnassia Psychiatric Institute, The Hague, a large mental health institute with branches across the Netherlands. He has conducted pioneering work on the epidemiology of eating disorders and has a particular interest in cultural psychiatry. In this episode of Big Ideas in Eating Disorders, Dr. Hoek shares his views on the complex and nuanced interplay of biology and environment associated with risk for developing an eating disorder.

Dr. Marsha Marcus, Professor Emerita at The University of Pittsburgh School of Medicine, has devoted a significant part of her career to the study of binge eating and the development of treatments for people with binge eating disorder. She started out with a focus on obesity treatment. During the course of her work, she noticed that a significant percentage of people seeking weight-loss treatment also described patterns of binge eating that contributed significantly to their health concerns and their distress. This observation catalyzed decades of clinical practice and research straddling the worlds of obesity and eating disorders. In this episode, Dr. Marcus describes her pioneering work and raises serious concerns about the ways in which science and advocacy are often conflated in the “Health at Any Size Movement” – to the detriment of the people who scientists, clinicians and advocates all want to serve.