Anorexia Current & Prior Research: Implications for Improved Treatment – Part 1

Man doing eating disorder research

Dr. Walter Kaye is a preeminent expert in eating disorder research, and he was generous in allowing Jacquelyn Ekern of Eating Disorder Hope to conduct an interview and present it on Eating Disorder Hope’s Virtual Conference “Anorexia Hope & Healing in 2018” held on May 17, 2018. This is his interview “Anorexia Current & Prior Research: Implications for Improved Treatment.”

Jacquelyn: What is your role in activities as Director of the Eating Disorder Treatment Research Program at UC San Diego Health?

Dr. Kaye: Well, I’ve been here for roughly ten years and, when I came here, one of the things I wanted to do was to look at the models of eating disorder treatment and try to advance the field by coming up with new and improved treatment approaches.

We do several things here. We have a large clinical program, and we have a very large biologic research program.

We also do something I find relatively unique, which is, we are trying to marry what we’re learning about the brain and behavior with better treatment approaches, which I will get into later.

In terms of treatment, when I started this program, I had previously been involved in running treatment programs at the National Institute of Mental Health in Pittsburgh.

These programs have been frustrating and disappointing in the sense that the relapse rate of eating disorders is very high, yet, treatments are very expensive and long-term.

At that point, I was very intrigued about family-based treatment as a new model, which brings family members in as allies with the idea being that these are often very chronic, long-term disorders and that, if you put someone in inpatient when they are discharged, the family doesn’t understand the disorder.

As a result, they don’t know how to manage and interact and get their child to eat and maintain their weight after discharge. Because of this, family-based treatment was really an advance and step forward.

We were part of the consortium with Stanford and other Senators to do a multi-center study and family-based treatment to another family treatment that had more psychosocial aims.

This was a great way of training our staff and forming alliances with others in the field and bringing the family-based treatment to San Diego.

The other thing we want to do is to see if we could do this treatment in a less-expensive way.

To get families to participate in traditionally family-based treatment has been done in outpatient settings.

What we started here was a day treatment of the evening partial program here. We also made a family-based treatment as the predominant treatment here for adolescents and children with these disorders.

Man Researching Dieting and Weighing Ourselves On His TabletNow, the program has really grown and we, actually, have separate programs for children, adolescents, and a separate program for adults.

The overarching goal of these programs is to deliver evidence-based treatment. If you’re going to provide evidence-based treatment, the title “evidence-based treatment” only applies if you follow the treatment the way it was designed and that was proven to be effective.

As such, we have set up a system that trains therapists and supervises them and continues to train them over time to deliver evidence-based kinds of treatments.

That can be a very expensive, laborious, and difficult thing to do but we’ve been able to do it successfully.

I think this has really fueled our growth because individuals and families that come here feel that they are getting a consistent treatment by informed therapists.

Jacquelyn: Absolutely! Now, you are doing research identifying genes that may contribute to the development of anorexia and bulimia nervosa, can you speak to that a little bit for us?

Dr. Kaye: Sure! I began my work in an era where there was a lot of technology being thrown at genetics, and there was the promise, and the hope, that we would be able to discover the genes that cause behavioral disorders.

Of course, we came from this from the perspective, at the time, that they were a single-gene disorder like sickle-cell anemia. We thought, if we discover the gene, we understand the disorder.

Unfortunately, behavioral disorders have turned out to be a lot more complicated than we thought they were going to be.

Now, it looks like there are many genes that contribute to each disorder, which has relatively small effects that may contribute to behavioral disorders.

It is probably going to take a lot longer to really understand the genetics of these disorders and find the genes and use those to develop more effective treatments.

I believe that the technology is there, it just isn’t going to happen continuously the way we’re hoping.

Jacquelyn: When you get disappointing results with studies, what do you and your team do?

Dr. Kaye: Typically, you continue to go down that avenue and just change course slightly. If you run into funding issues or something like that, you may have to abandon some research and go in a different direction.

Research on Genetic Factors

I think you look at the data and take a step back and say “gee, we didn’t get the results that we wanted to get, why is that? What were our assumptions? What was the reality of the situation?”

What we were discovering is that we could take lessons from other illnesses like Autism Spectrum Disorder or breast cancer.

In these disorders, we are learning that there are systems that are involved in Autism and that these systems may be very important for development at synapse formation.

In breast cancer, it may be systems that are very important in correcting DNA that becomes disturbed and that genetics plays a role in these disorders.

There are many ways to screw up these systems, and it may be that everybody with Autism or breast cancer may have their own unique illness, their own specific system that gets impaired with a cause that is unique to that person.

The ultimate lessons are that we need to look at eating disorders and say “what is the system that is involved in the brain that causes people to restrict eating or engage in binge/purge behaviors? What is the genetic architecture of those systems?”

In following these questions, we begin to tease it apart so we don’t throw out information or research but that, as we learn more about the biology of the brain and behavior, we come at the data from a more sophisticated, successful approach.

TO BE CONTINUED IN PART II…


Source:

Virtual Presentation by Dr. Walter Kaye in the May 17, 2018, Eating Disorder Hope Online Conference II: Anorexia Hope & Healing in 2018.

Please view the press release Here.


Author:

Dr. Walter Kaye was recruited to the UC San Diego faculty from the University of Pittsburgh School of Medicine, where he was research director of the eating disorder program, and where he received an NIMH senior scientist award.

Dr. Kaye’s current research is focused on exploring the relationship between brain and behavior using brain imaging and genetics, and developing and applying new treatments for anorexia and bulimia nervosa. He is the principal investigator for an international, multi-site collaboration on the genetics of anorexia and bulimia nervosa. He has an international reputation in the field of eating disorders and is the author of more than 300 articles and publications. He attended Ohio State Medical School, trained in neurology at the University of Southern California and trained in psychiatry at the University of California, Los Angeles. Dr. Kaye was then a fellow and research physician at the National Institute of Mental Health for seven years where he conducted research on appetite regulation, behavior, and treatment for disorders.

As Director of the University of California, San Diego Eating Disorder Treatment and Research Program, Dr. Kaye and his clinical team are treating anorexia nervosa and other eating disorders with an innovative, intensive program that approaches the problem on multiple levels, including medical, psychological, psycho-educational and counseling of the family as key support group.


Image of Margot Rittenhouse.About the Transcript Editor: Margot Rittenhouse is a therapist who is passionate about providing mental health support to all in need and has worked with clients with substance abuse issues, eating disorders, domestic violence victims, and offenders, and severely mentally ill youth.

As a freelance writer for Eating Disorder and Addiction Hope and a mentor with MentorConnect, Margot is a passionate eating disorder advocate, committed to de-stigmatizing these illnesses while showing support for those struggling through mentoring, writing, and volunteering. Margot has a Master’s of Science in Clinical Mental Health Counseling from Johns Hopkins University.


The opinions and views of our guest contributors are shared to provide a broad perspective of eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer a discussion of various issues by different concerned individuals.

We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.

Published on August 28, 2018.
Reviewed & Approved on August 28, 2018, by Jacquelyn Ekern MS, LPC

Published on EatingDisorderHope.com

About Baxter Ekern

Baxter is the Vice President of Ekern Enterprises, Inc. He is responsible for the operations of Eating Disorder Hope and ensuring that the website is functioning smoothly.