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Star Bulletin Alan Titchenal & Joannie Dobbs Health Options
Joannie Dobbs
 & Alan Titchenal
                    Monday, June 1, 2009


Normalizing nutrition eases eating disorders

With the onset of summer comes the wearing of lighter clothes and swimsuits. Along with the seasonal fashion change, people of all ages typically become more concerned about their body image and, consequently, their diet.

Not surprisingly, studies report that many adolescents are dissatisfied with the shape and size of their body. Research also reveals a link between exposure to popular media and disordered eating symptoms that often develop into eating disorders. When weight loss goes too far, the risk greatly increases for developing a serious eating disorder such as anorexia nervosa.

Anorexia nervosa is a condition in which a person consumes inadequate calories to maintain a normal body weight. Perhaps the glut of media images of excessively thin models and actresses has made it difficult to keep a normal perspective on body shape and be aware of the many short- and long-term health problems often associated with the pencil-thin image.

Sadly, as dieting progresses, "media victims" can become out of touch with normal eating and hunger sensations and the anorexia becomes serious and even leads to death in up to 20 percent of those with the condition. The success rate for traditional treatment of individuals with anorexia nervosa is very poor, with less than half recovering.

Question: Is anorexia nervosa a psychological disorder?

Answer: Certainly, anorexia nervosa does result in serious psychological disturbances such as depression, anxiety and obsession. However, there is currently hot debate about which comes first. Does disordered eating and poor nutrition lead to these psychological problems? Or, do the psychological problems develop first and cause the disordered eating behaviors? Though still debatable, there is a growing body of research claiming that disordered eating can be the trigger of the psychological problems.

Q: What treatments for anorexia are most successful?

A: To date, the most well-studied successful treatment approach was developed in Sweden. Dr. Per Soedersten at the Karolinska Institute claims that the psychological problems are a result of the anorexic condition, not the cause. Based on about 500 patients treated in their clinics, 75 percent went into full remission and 90 percent of these have remained free from symptoms of an eating disorder for five years or longer. No other treatments have documented such excellent results.

Q: What are the techniques used for this treatment?

A: The institute treats anorexia by normalizing nutrition rather than using psychological therapies. Patients are gradually trained to eat normally again. To do this, Soedersten's group uses a device called a Mandometer. This device is a computerized plate scale that monitors how fast and how much the patient is consuming. As they eat, the Mandometer provides feedback to help the patients learn to eat at a normal pace and to become more sensitive to their satiety cues.

In addition, patients must rest in a warm place after eating so that they are comfortable and less likely to feel the drive to exercise excessively. As the nutritional state gradually normalizes, the usual psychological problems resolve. For more information about this treatment, go to

Joannie Dobbs, PhD, CNS and Alan Titchenal, PhD, CNS
are nutritionists in the Department of Human Nutrition, Food and Animal Sciences,
College of Tropical Agriculture and Human Resources, UH-Manoa.
Dr. Dobbs also works with the University Health Service

© 2009 Honolulu Star-Bulletin --

Human Nutrition, Food & Animal Sciences · University of Hawai`i at Mānoa
1955 East-West Road · Honolulu, HI 96822
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