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She fought to save her child from an eating disorder. Now, she combats the misconceptions.

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Nine years ago, JD Ouellette almost lost her then 17-year-old daughter Kinsey to an almost fatal anorexia nervosa. Kinsey has since recovered, but her mother is still in the trenches helping other parents and children in San Diego teach the tools and strategies they need to win their own battle against eating disorders.

According to the National Eating Disorders Association, EDs will affect approximately 20 million women and 10 million men in America during their lifetime. These conditions include anorexia and bulimia nervosa, as well as binge eating and eating disorders that restrict avoidance. They can affect people of any age, ethnicity, and socio-economic group. They can occur in children as early as 7 years of age and are particularly common in women between the ages of 15 and 24. Unfortunately, only about 10 percent of people with eating disorders are ever treated.

Ouellette, a 57-year-old mother of four from Scripps Ranch, said parents may not be able to spot the signs due to widespread myth and outdated information online. New research over the past 20 years has dramatically changed scientists’ knowledge of these diseases and their treatments, Ouellette said that sharing this new information with families can save lives.

“What I’m telling parents is to trust their Spidey sense,” Ouellette said, referring to Spider-Man’s oversensitivity to danger. “If you feel like something is wrong, especially after reading it in the Union-Tribune, get a review right away.”

JD Oullette stands outside the UC San Diego Health Eating Disorders Center in La Jolla.

(Ariana Drehsler / The San Diego Union-Tribune)

In 2012, Kinsey Ouellette underwent treatment at the UC San Diego Eating Disorders Center for Treatment and Research in La Jolla, widely recognized as one of the leading eating disorder research organizations in the country. JD Ouellette said she was so grateful for her daughter’s recovery that she volunteered to look after other parents of children starting treatment. When the university where she worked as an administrative specialist was closed in 2018, she devoted herself entirely to her new calling.

Today she runs her own coaching service for parents and patients with eating disorders; serves as a parenting mentor on the University of California Center’s Parents Advisory Board at San Diego; is the mentor for EQUIP, a 2-year program for the treatment of fully virtual eating disorders in San Diego; is a co-founder of the International Eating Disorders Family Support Network and the World Eating Disorders Action Day; and is a former board member for Families Empowered and Supporting Treatment of Eating Disorders (FEAST).

Ouellette said that most Americans, and a surprising number of pediatricians, fail to realize that eating disorders is not a personal “choice” but an inherited, genetic, neurobiological disorder. Although they can be triggered by social or environmental factors (such as bodyshaming or the media promotion of thin body types), they should be understood as complex medical and psychiatric diseases.

“One of the greatest things I’ve learned is that everything I thought I knew about EDs was just plain wrong,” she said. “I was a teacher with a master’s degree and was wrong.”

Decades ago, traditional treatment for young people with severe eating disorders was removing them – or a “parental ectomy,” as Ouellette calls it – because parents were seen as the cause of the problem. Now, according to Ouellette, research has shown that the most effective method is called family-based treatment, where a patient’s family is part of the trained “team” that guides the patient to physical and emotional health at home.

“No family causes an eating disorder, but every family needs to change to fight an eating disorder,” said Ouellette. “Think of it this way: your family’s operating software does not have an ED control patch, so you need to update your software to the version that combats ED.”

Ouellette said teens with these disorders share temperamental traits in common. They are often great students and high performing athletes and artists who work hard, are internally motivated, and used to practicing perfectly.

“These are very valuable skills, but once you develop ED, the same discipline applies. There is a light and a dark side to these skills, ”she said.

That was the case with Kinsey, who was a top student and high school athlete. After graduation, she and a few friends decided to “re-model” a “healthy diet” to avoid the “new 15” pounds that students often put on in their freshman year of college, but within two months of starting the makeover, Kinseys became Health so precarious that her family urged her to seek treatment at UC San Diego.

“Some people burn slowly, but it was a long way from the cliff. It was amazing, ”said Ouellette. “She has said many times in the years since that if we hadn’t intervened, she would have been dead within a few months.”

“Think about your disorder as a person. If your child screams, yells, throws objects, refuses to eat, negotiates meals, whatever it is, you are not witnessing or interacting with your actual child. You are face to face with the personification of their disorder. “

Kinsey, the daughter of JD Oullette, as she wrote in an essay about her eating disorder

Ouellette said family-based treatment works, but it’s not easy. Marriages can break up and parent-child relationships can be permanently broken without the support of a comprehensive treatment program like the one at UC San Diego, Rady Children’s Hospital in San Diego, or EQUIP.

“If a plate of food is like a plate of snakes and spiders for a child, they will behave appropriately, and that’s hard for anyone,” Ouellette said. “It’s really easy for parents to feel like you are against their child, but in reality, it is you against the eating disorder your child is controlling.”

In an essay, Kinsey wrote about her battle with anorexia for FEAST, she said that children affected by an eating disorder will say and do almost anything if they believe their parents are in the way of their weight goal.

“Think about your disorder as a person,” wrote Kinsey. “If your child is screaming, yelling, throwing objects, refusing to eat, negotiating meals, whatever it is, you are not experiencing or dealing with your actual child. They face the personification of their disorder. That hatred comes from a losing eating disorder. So remember that the more hate you feel, the better you work. “

Treatment and recovery outcomes vary, but Ouellette said that in most cases, aggressive treatment can resolve the disorder in three to four months, but it can take one to three years to achieve full recovery. Relapses are common. Some studies show a relapse rate of 36 percent in anorexic patients and 35 percent in bulimic patients.

Ouellette said she advises parents who are having difficulty treating their child to focus on the end goal and stay on track.

“It is important that you approach this with compassion, consistency, and with the knowledge that whatever you do is protection, even if it feels like punishment or seems filtered,” she said. “Feeding our children and monitoring exercise and other behaviors in order to achieve and maintain their optimal physical and mental health is our right and responsibility as parents.”

Common warning signs of an eating disorder

  • Sudden weight loss or weight gain
  • Eating disorders, such as skipping breakfast or lunch habitually
  • Take part in fasting challenges or keep track of everything you eat in a day
  • Sudden change in mood or socializing habits
  • Self-esteem problems related to body image
  • Decision for vegans or vegetarians
  • Anxiety or depression
  • Exercise compulsion
  • Eating rituals (such as over-chewing or not touching food)
  • Girls experience irregular menstruation or a break in menstruation
  • Boys with focus on bodybuilding and body fat
  • Dizziness or fainting
  • Stomach cramps or acid reflux
  • Sleep disorder
  • Cuts and calluses on the top of the finger joints (from vomiting)
  • Yellow skin (eaten from too many carrots)
  • Difficulty concentrating
  • Dry skin and hair

– Source: National Association for Eating Disorders

Self-care tips for parents of a child with an eating disorder

  • Learn psychoeducation, which is a therapeutic intervention for patients and family members to understand and manage illness.
  • Work with providers to equip them with the same skills that you are teaching your child.
  • In order to avoid conflict, both parents should remain on the same side when treating their child.
  • Divide up the responsibilities in your family, ideally so that the father can take on a more active role.
  • Engage in bonding activities with your child in treatment.
  • Do guided meditation for at least five minutes a day.
  • Learn to play a musical instrument.
  • Go outside and take a walk.
  • Avoid activities that cause stress.

– Source: JD Ouellette

Resources:

National Association for Eating Disorders – nationaleatingdisorders.org
Families supports and supports the treatment of eating disorders (FEAST): fest-ed.org
UC San Diego Center for Treatment and Research for Eating Disorders – eatdisorders.ucsd.edu
Rady Children’s Hospital-San Diego Eating Disorders Treatment Unit – rchsd.org
EQUIP virtual family-based treatment program – equip.health
Parent and patient coaching by JD Ouellette: jdouellette.com

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Open up about barriers rural residents face in getting help for mental health

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We’re tight-lipped in the farmland. To suffer in silence seems to be the way we have been taught. But I think we need to acknowledge and address our problems. October 10th was World Mental Health Day and gave me a nudge. It’s okay to admit that we’re not okay. Write it down on a health questionnaire. Tell your doctor. Be honest and give voice to your mental health, not just for yourself but for those who love you, who need you.

Mental health is important for everyone, whether in cities or in the country. Photo by Kallie Coates / Grand Vale Creative LLC

In the city or in the country, we are alike when it comes to mental suffering and stigma. The difference is that those of us in non-urban areas face three additional mental health challenges. According to the Rural Health Information Hub, these challenges include:

  • Accessibility: “Rural residents often travel long distances to use services, are less likely to have psychiatric insurance and are less likely to recognize an illness,” says RHIhub. Personally, I’m insured, but if I keep an appointment I’ll take two to four hours off from work to attend. There have been instances where I’ve taken a full day off to do a 200-mile round-trip for a counseling appointment. Not all rural residents can change this schedule. Telemedicine options have been expanded by the pandemic. I hope telemedicine continues to improve mental health accessibility.
  • Availability: I love rural clinics and support them with routine health care. However, at the moment I have no possibility of psychological support in a rural health clinic. According to RHIhub, “there is a chronic shortage of mental health professionals and mental health providers are more likely to practice in urban centers.” I called an expert I had seen years ago after a new appointment and was told they were six would book up to a year for new dates. At first, I had empathy for the person who had to answer the phone and make appointments. Next, I thought of those in the mental health services industry who are unable to get in touch with everyone who wants to see them. We need more experts. I still want to see this professionally and personally. I will wait for your appointment. I will also see another professional on video sooner.
  • Acceptance: The first time I wrote about mental health in this column, I received feedback from someone who felt they knew me enough in real life to comment and say I had the mental health issues or the reality Not really familiar with the effects of mental illness is a family disease. She was wrong. I usually don’t stick with the haters or negative feedback, but it did for a while. Then came a person who personally thanked them for talking about mental health. Don’t let this stop you from seeking professional mental health help. “The stigma of needing or receiving psychiatric care and the limited selection of trained professionals who work in rural areas create barriers to care,” says RHIhub. We can break down barriers by saying that it is okay to seek psychological help for you or your loved ones.

Be honest and give voice to your mental health, not just for yourself but for those who love you, who need you, says Katie Pinke.  Erin Brown / Grand Vale Creative

Be honest and give voice to your mental health, not just for yourself but for those who love you, who need you, says Katie Pinke. Erin Brown / Grand Vale Creative

We are all affected by mental health problems. Unless you have any mental health problems or severe mental illness, you know someone who is. Add in a global health pandemic and we’re more isolated now than we were two years ago. Don’t be silent about mental health or serious mental illness. When someone confides in you, help them get in touch with professional help. Listen more than talk. Showing up with your presence is a difference maker.

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You are not alone. You are needed. You are loved. Your presence is a crucial part of someone’s community. I made a deliberate decision not to let the waves of fear swallow me up that I sometimes feel. I fight it with a network of support. I also know that a healthy lifestyle, regular exercise, fresh air, quiet time in my beliefs, and a few things for myself that I enjoy have positive effects on my mental health.

Caring for our mental health is just as important as caring for our physical health. Let’s start by breaking down the rural mental health barriers of availability, accessibility, and acceptance by seeking the help we need regardless of the travel time, waiting time for appointments, or the stigma we need to overcome.

To read more of Katie Pinke’s The Pinke Post columns, click here.

Pinke is the editor and managing director of Agweek. You can reach her at kpinke@agweek.com or connect with her on Twitter @katpinke.

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Facebook should modify algorithms to make social media safer for teens

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Talk to a pediatrician and we will tell you: We are going through a mental crisis in teenagers. The pandemic has brought school closings and stay-at-home restrictions that resulted in social isolation among youth. With more than 721,000 COVID-19 deaths across the country, many teens know a deceased person personally and in some cases have even lost a parent.

Unsurprisingly, pediatricians like us are at the forefront of caring for more than twice as many teenagers struggling with depression, anxiety, and eating disorders.

With this in mind, social media giant Facebook – owner of Instagram, a platform used by more than half of teenagers in the United States – plays a key role. Amid these rising and unprecedented rates of mental illness among teenagers, will Facebook be part of the problem or the solution?

Instagram and eating disorders

Whistleblower and former Facebook product manager Frances Haugen recently testified before Congress that internal research by the company showed that Instagram may have worsened the mental health of young people. In these studies, teenage girls reported feeling worse about their bodies on Instagram, increasing eating disorders, and having thoughts of suicide more often.

We’ve seen examples of this at our own eating disorders clinic, where teenagers often tell us Instagram exposes them to posts that perpetuate unrealistic body shapes and share harmful diet tips.

Facebook’s internal research confirms a 2018 study by the Pew Research Center that shows 1 in 4 teenagers say social media negatively affects their lives because they experience bullying and harassment, unrealistic views about their lives Develop colleagues and get distracted from spending too much time online.

Again, these are concerns we often hear from teenagers in our practice. Such issues are likely to be compounded among teenagers who spend more time on social media, which is particularly worrying given that nearly 90% of teenagers who visit Instagram and other platforms do so several times a day.

This time of immense control presents Facebook with a pivotal opportunity to support, rather than hurt, teenage mental health. Legislators have proposed stepping in and regulating the platform, and as pediatricians we are inclined to support these measures if they are aimed at improving the health and wellbeing of teenagers. However, despite regulation, social media is likely to play a permanent role in teenage lives for years to come. Facebook should seize this moment to take action to clearly improve and support teenage mental health.

Larry Strauss:A teacher’s question: Social media harms my students, but do technical executives even care?

Perhaps most importantly, Facebook and other social media companies should reinforce healthy messages. In the same study by the Pew Research Center, 1 in 3 teenagers reported that social media had a positive impact on their lives, most often because it helped them connect with others or find important information.

However, algorithms in Facebook and Instagram – which are kept secret from public scrutiny – are based on how many people like, share and comment. This approach encourages bombastic, misleading, and unhealthy posts.

We need health-oriented algorithms

Instead, social media companies could specifically curate and actively promote messages about health and wellbeing. Numerous pediatric influencers (e.g. @teenhealthdoc, specialist in youth health in New York) already offer evidence-based advice and health information for adolescents and their families on Instagram and other platforms. Facebook could set up an advisory board of clinicians to assess the quality of influencers’ posts, offer health care providers a review (with the invaluable “blue check mark” that shows a user is authentic and remarkable), and make their posts accessible to a youthful audience do.

Social media companies should also encourage young people to post accurate, health-promoting content themselves.

Tom Kistenmacher:Facebook Revelations: Social Media Strengthened Our Voices, But Impaired Our Hearing

This approach would require Facebook to change its algorithms, which the company is likely to resist unless regulation enforced. Social media companies have come under constant fire for being too late to respond to misleading or harmful posts, which contributes to bad press and negative regulatory attention.

We claim that Facebook should be proactive in its approach and promote high quality content that is interesting to teens. Done right – with an infusion of creativity, thoughtful design, and humor – positive, health-promoting posts can receive a tremendous number of likes, shares, and comments, but may need to be actively promoted amid the negative messages currently prevailing. Realizing that it has a duty to block misinformation about COVID-19, Facebook must take similar steps to protect teenagers’ mental health.

Facebook can also help facilitate moderation in the use of its platforms among teenagers. The current business models of social media companies are driven by the persistent, compulsive use of their products and the advertising revenue they generate. In his credit, Facebook has imposed advertising restrictions on teenagers.

The company should build on this by helping teenagers put their smartphones down. To reduce screen time, Apple introduced Screen Time, an iPhone and iPad integration that allows parents to limit the time teens spend using social media apps. However, workarounds are easy to find for teenagers. Facebook should introduce its own functionality that would allow parents to limit teenagers’ use of its platforms.

We will address the after-effects of COVIC-19 on teenage mental health in the years to come. The reality is that while many of us pediatricians would like to remove social media from the lives of our teenage patients altogether, Instagram and other popular platforms are going nowhere. Social media companies wield tremendous power over young people. You should use it to empower – not hinder – the hard work we frontline pediatricians do to fight mental illness.

Dr. Scott Hadland is the Chief Medical Officer of Adolescent Medicine at MassGeneral Hospital for Children and Harvard Medical School (@DrScottHadland on Twitter and Instagram). Dr. Kathryn Brigham is the medical director of the Teenage Eating Disorders Program at MassGeneral Hospital for Children and Harvard Medical School.

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Study finds a downward trend in buprenorphine misuse among U.S. adults with opioid use disorder

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Data from a nationwide representative survey shows that in 2019, nearly three-quarters of US adults who used buprenorphine had not abused the drug in the past 12 months. In addition, buprenorphine abuse among people with opioid use disorder declined between 2015 and 2019, although the number of people receiving buprenorphine treatment increased. The study, published today on the JAMA Network Open, was conducted by the National Institute on Drug Abuse (NIDA), part of the National Institutes of Health, and the Centers for Disease Control and Prevention.

Buprenorphine is an FDA-approved drug used to treat opioid use disorders and to relieve severe pain. Buprenorphine, used to treat opioid use disorders, works by partially activating opioid receptors in the brain, which can help reduce opioid cravings, withdrawal, and general use of other opioids.

In 2020, more than 93,000 people lost their lives to drug overdoses, with 75% of those deaths being caused by an opioid. In 2019, however, fewer than 18% of people with last year’s opioid use disorder were receiving medication to treat their addiction, in part because of stigma and barriers to accessing those medications. To prescribe buprenorphine for the treatment of opioid use disorders, doctors must do so as part of a certified opioid treatment program or submit a letter of intent to the federal government, and the number of patients they can treat at the same time is limited. Only a small fraction of doctors are authorized to treat an opioid use disorder with buprenorphine, and even fewer prescribe the drug.

Quality medical practice requires the provision of safe and effective treatments for health conditions, including substance use disorders. This includes providing life-saving drugs to people with an opioid use disorder. This study provides further evidence of the need for expanded access to proven treatment approaches such as buprenorphine therapy, despite the remaining stigma and prejudice that persists in people with addiction and the drugs used to treat them. “

Nora D. Volkow, MD, NIDA director

In April 2021, the U.S. Department of Health released updated guidelines for buprenorphine practice to expand access to treatment for opioid use disorders. However, barriers to the use of this treatment persist, including doctor’s discomfort in treating patients with opioid use disorder, the lack of adequate insurance coverage, and concerns about the risks of distraction, abuse, and overdose. Abuse is defined as patients taking medication in a manner not recommended by one doctor and may include consuming someone else’s prescription medication or taking their own prescriptions in larger quantities, more frequent doses, or for a longer duration than directed.

To better understand buprenorphine use and abuse, researchers analyzed data on prescription opioid use and abuse, including buprenorphine, from the National Surveys on Drug Use and Health (NSDUH) 2015-2019. The NSDUH is conducted annually by the Department of Substance Abuse and Mental Health. It provides representative data on prescription opioid use, abuse, opioid use disorder, and motivation for recent abuse in the civil, non-institutionalized US population nationwide.

The researchers found that nearly three-quarters of US adults who reported using buprenorphine in 2019 had not abused buprenorphine in the past 12 months. In total, an estimated 1.7 million people reported taking buprenorphine as prescribed in the past year, compared to 700,000 people who reported using the drug. In addition, the proportion of patients with opioid use disorder who have abused buprenorphine has tended to decline over the study period, although the number of patients who received buprenorphine treatment has increased recently.

Importantly, in adults with an opioid use disorder, the most common reasons for recent buprenorphine abuse were “because I am addicted to opioids” (27.3%), suggesting that people are using buprenorphine over the counter for self-treatment of cravings and withdrawal may have symptoms related to an opioid use disorder and “to relieve physical pain” (20.5%). In addition, adults who took buprenorphine were less likely to have buprenorphine abuse among those who received drug treatment than those who did not. Taken together, these results illustrate the urgent need to expand access to buprenorphine treatment, as receiving treatment can help reduce buprenorphine abuse. In addition, strategies need to be developed to further monitor and reduce buprenorphine abuse.

The study also found that people who did not receive drug treatment and those who lived in rural areas were more likely to abuse drugs. However, other factors, such as belonging to a racial / ethnic minority or living in poverty, did not influence buprenorphine abuse. The study authors suggested that addressing the current opioid crisis should improve both the access to and quality of buprenorphine treatment for people with opioid use disorder.

“Three-quarters of adults taking buprenorphine do not abuse the drug,” said Wilson Compton, MD, MPE, NIDA associate director and lead author on the study. “Many people with opioid use disorder need help, and as clinicians we need to treat their condition. Use disorder can access this life-saving drug.”

Source:

National Health Institute

Journal reference:

Han, B., et al. (2021) Trends and Characteristics of Buprenorphine Abuse Among Adults in the United States. JAMA network open. doi.org/10.1001/jamanetworkopen.2021.29409.

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