Groundbreaking study of anorexia

Mar 12 2007

New York-Presbyterian Hospital's Westchester Division (NYPH) will participate in a National Institute of Mental Health (NIMH) clinical research study of anorexia nervosa, the serious and potentially lethal eating disorder that mostly afflicts teenage girls.

The groundbreaking collaborative undertaking, which will also include the participation of five other leading medical research institutions, will begin accepting patients who wish to participate on May 1.

The four-year study represents the first randomized controlled study of two early intervention therapeutic approaches for children between the ages of 12 and 18 who have been diagnosed with anorexia nervosa. The participation of the children's parents will be a key component of the study.

The NewYork-Presbyterian/Westchester team will be led by Dr. Katherine Halmi, one of the pioneering and internationally recognized eating-disorders experts. For more than 25 years, Dr. Halmi has been engaged in eating-disorders research at the Hospital. A professor of psychiatry at Weill Cornell Medical College, Dr. Halmi is also founder and director of the NewYork-Presbyterian/Westchester Eating Disorder Treatment Program, one of the nation's first multi-disciplined, clinically-based treatment programs. Since the program was established in 1980, hundreds of patients suffering from various types of eating disorders have been treated on both an outpatient and inpatient basis at the Hospital.

Dr. Halmi's team of researchers has received ongoing support from the NIMH for the past 20 years. Currently under way is the Genetics of Anorexia Nervosa study to determine which genes play a role in the development of anorexia nervosa. The Hospital, along with five other U.S. and three international research institutions, is studying families in which two or more relatives have suffered from anorexia nervosa.

"We've learned a lot about this highly complex disorder and we now know that genes play a substantial role in determining who is vulnerable to developing eating disorders. We also know that early intervention involving the participation of family members during the adolescent years has proven extremely important in successful treatment," says Dr. Halmi.

She adds: "Environmental factors such as society's emphasis on being overly thin may serve as a trigger that increases the risk in an individual who is genetically pre-disposed. Although less than half of 1 percent of all women develop this disorder, anorexia nervosa has the highest death rate of any mental illness, which makes the controlled treatment studies we will be conducting extremely important in enhancing our understanding of anorexia nervosa and in developing effective therapeutic treatment plans."

Stanford University will serve as the training and data center for the study. In addition to NewYork-Presbyterian/Westchester, the other institutions that will participate are Washington University, the University of California (San Diego), Laureate Clinic, Shepherd Pratt Clinic and the University of Toronto. Altogether, 240 young patients will participate.

Dr. Halmi says that there is no proven treatment for the disorder that is characterized by individuals seeing themselves as overweight even though they are dangerously thin. "This is a psycho-physiological disorder characterized by an abnormal fear of becoming obese, a distorted self-image, a persistent unwillingness to eat, and severe weight loss. It is often accompanied by self-induced vomiting, excessive exercising, malnutrition, and other harmful physiological changes."

Dr. Halmi notes that researchers are seeking to improve the chances for recovery. "Currently, only a quarter of patients with anorexia nervosa fully recover and half have partial improvement but another 25 percent remain chronically ill. There is also a 40 percent rate of relapse. Our hope is that aggressive and sustained research will help us to make significant inroads in better understanding the root causes of the disorder and finding the best treatment programs."

As a leader in eating disorders, NewYork-Presbyterian/Westchester was designated by New York state a few years ago as one of only three state comprehensive care Centers of Excellence (COE) for Eating Disorders. The COE is a program initiated under the leadership of New York State Senate Majority Leader Joseph Bruno. Heightened interest in eating disorders as a "public health concern" was underscored more recently when Gov. Eliot Spitzer, in his proposed 2007-2008 budget, allocated $100 million to fund provisions designed to expand health insurance coverage for mental health care including eating disorders.

In addition, state Assemblyman Jose Rivera of the Bronx introduced legislation to create an advisory board that would submit proposed standards such as body mass index requirements to employers of models and weight requirements for child performers who are under 18 years of age.

Dr. Halmi states, "Helping New Yorkers obtain expanded health insurance coverage for the treatment of eating disorders and creating health benchmarks for the fashion and entertainment industries are welcome and necessary initiatives."

The new NIMH research project will be conducted within the framework of NYPH's Eating Disorder Treatment Program. The program's team comprises physician-psychiatrists, pediatricians and internists, psychologists, therapeutic activities professionals, nurses and mental health professionals.

The program includes both an outpatient clinic and a 17-bed inpatient unit for emaciated and severely compromised eating-disorder patients. A multi-dimensional approach to treatment includes individual and family therapy, a variety of group therapies that address specific core eating-disorder psychological and behavioral problems, and medical care. Strong emphasis is placed on vocational evaluation and counseling to help the patients return to the community and maintain a higher quality of life.