Earlier Diagnosis and Treatment Helps Stem Eating Disorders

Earlier Diagnosis and Treatment Helps Stem Eating Disorders

From the LA Times: 

A new breed of patient is getting treatment well before the disease drags them into a downward spiral toward starvation, sustained heart damage, weak bones, kidney damage, long hospitalizations and numerous relapses.

Health experts are seeing a glimmer of hope that the devastation wrought by eating disorders may be easing nearly 30 years after the illnesses first sprang into the public consciousness with the death of singer Karen Carpenter from anorexia-induced heart failure. Among the encouraging signs: More patients are getting medical treatment based on sound science; they're getting it earlier in the course of the disease; and they're recovering faster, often without the need for hospitalization or residential care.

One eye-opening statistic appears to speak to the trend: A recent government analysis found that hospitalizations for people with the primary diagnosis of an eating disorder plunged 23% between 2007-08 and 2008-09. It was the first such decline since the federal Agency for Healthcare Research and Quality began tracking such hospitalizations in 1999.

"Any little movement is significant, and this is a pretty big one," said William Encinosa, a senior economist at the agency who worked on the report, which was published last year.

Eating disorders, which primarily affect teenage girls, are loosely categorized as mental illnesses centered on obsessive thoughts, emotions and behaviors regarding food. Anorexia involves self-starvation leading to excessive weight loss that damages the heart, bones, nervous system and organs. An estimated 1 in 200 Americans has the disease, and the death rate is 4%.

Bulimia is characterized by bingeing followed by self-induced vomiting, use of laxatives or excessive exercise to purge food and prevent weight gain. It affects 2% to 3% of Americans and is not thought to be as deadly as anorexia, though a 2009 study in the American Journal of Psychiatry found it was lethal in nearly 4% of cases, mostly due to suicide or electrolyte imbalance caused by dehydration.

Another type of eating disorder, binge eating, rarely leads to hospitalization or death.

The stigma surrounding anorexia and bulimia have kept many patients isolated. But for a variety of reasons, eating disorders are coming out of the shadows.

Surveys conducted by the National Eating Disorders Assn. show that Americans are more familiar with anorexia and bulimia now than they were 10 years ago. That awareness has been accompanied by a weakening of the stigma associated with eating disorders that might, in the past, have prevented some people from seeking help quickly, said William Walters, who manages the telephone hot line for the New York-based organization.

"Parents are being more proactive. Coaches are being more proactive about their athletes," he said. "People feel they can ask for help."

Encinosa credits the heightened awareness to a combination of education in schools, TV shows on the topic and public statements by such celebrity patients as Princess Diana and Paula Abdul.

In April Dunlap's case, a made-for-TV movie about two high school students with eating disorders put her mother, Gloria, on alert. When April began her rapid weight loss, Gloria took action.

"I could see it wasn't normal," Gloria Dunlap said.

Some experts are skeptical that the big drop in hospitalizations reflects actual improvement in treatment. More insurance companies are steering patients to outpatient programs or partial hospitalization, in which patients attend day programs but go home at night, said Dr. Ovidio Bermudez, medical director of the Eating Recovery Center in Denver. Perhaps the drop in hospitalizations simply means insurers are being stingy.

Nor does the federal data indicate whether deaths from eating disorders have declined, since mortality rates are not tracked.

There is no evidence that the incidence of eating disorders has dropped, Bermudez said. To the contrary, anorexia and bulimia have been spreading among populations other than white teenage girls.

Read the entire story here: http://www.latimes.com/health/la-he-eating-disorders-20120417,0,5984467.story

Alternative Medicine Treatments from Hospitals?

From NPR.org 

Hospitals are going alternative. Forty-two percent now offer at least one type of complementary or alternative medicine treatment, according to a recent survey by the American Hospital Association and the Samueli Institute, a nonprofit research organization that focuses on these treatments.

What hospitals choose to offer runs the gamut, from well-known therapies such as acupuncture to less familiar treatments like reiki, in which practitioners channel a patient's energy by placing their hands on or just above specific locations on the body.

Patient demand is the top reason hospitals offer complementary and alternative therapies, cited by 85 percent. Clinical effectiveness? That comes in second, at 70 percent.

Though eager to please, hospitals are generally only willing to go so far. They typically draw the line at herbal or nutritional supplements. Eighty-two percent of hospitals said they don't sell herbs in their hospital pharmacies, and 55 percent don't sell nutritional supplements. Two-thirds said they have policies regarding using such products during a hospital stay.

There's a big difference between guided imagery and ginkgo supplements, say experts. While patients are unlikely to be harmed by the mostly noninvasive therapies hospitals have adopted so far, herbs and supplements may pose a greater threat.

An extract made from the seeds and leaves of the Ginkgo biloba tree, for example, is taken by some people to improve memory and fight dementia, despite mostly inconclusive study results.

The herb does, however, increase the risk of bleeding, and patients should discontinue its use 36 hours prior to surgery. "Many herbal remedies create herb/drug interactions," says Barrie Cassileth, chief of the integrative medicine service at Memorial Sloan-Kettering Cancer Center in New York, which maintains a website with information on 250 herbs and supplements. "Many of them are not standardized, and frequently they are dirty, contaminated and unproven," she says. 

 That hasn't seemed to bother Americans, who spent $14.8 billion on such products in 2007, according to the National Center for Health Statistics. That's an amount equal to one-third of their total out-of-pocket spending on prescription drugs. All too often, however, patients don't offer up details to their doctors about what natural remedies they're taking on their own.

These days, hospitals generally ask about such use, but if they don't: Tell them. You could save yourself and the hospital a lot of trouble.

For original article read: NPR: HEALTH: HOSPITALS OFFER ACUPUNTURE / ALTERNATIVE TREATMENTS