Disordered: What causes kids to lose control over eating?

An 11-year-old boy – let’s call him Enrico – had a tough day at school. He’d done poorly on a math test – again – and some boys picked on him during gym because he’d missed an important free throw. Enrico walked home from the bus, let himself into the house and grabbed an unopened extra-large package of chips. He took one, then another; he ended up methodically eating the entire package, even though he’d even felt a little sick half way through. He simply couldn’t stop himself. It wasn’t the first time it had happened; in fact, it had gone on long enough that Enrico had started to become overweight.

shutterstock_39643708A hypothetical story, but not an unusual one. Loss of control (LOC) eating is the most common disordered eating behavior in overweight kids, even pre-adolescents. A mental disorder that causes people to lose control of the amount or type of food they ingest, binge eating is also the most common eating disorder in the United States. Up to half of adults who seek weight loss treatment may suffer from it – and those who do often report that they began having weight problems at a younger age. In some cases, binge eating promotes excess weight gain and obesity.

Marian Tanofsky-Kraff, an Associate Professor at the Uniformed Services University of the Health Sciences, says many of the issues that predict obesity are also linked to eating disorders. It’s an evolving field; binge eating was only last year classified as a disorder by the American Psychiatric Association. Like the obesity epidemic itself, the causes of binge eating in kids are varied and complex, from anxiety to environmental triggers.

“Our obesogenic environment promotes loss of control. When we were in school, there weren’t birthday cupcakes every day of the month. We weren’t surrounded by junk food. I’ll hear about kids in a Saturday morning dance class whose moms make a list of who’s bringing brownies for the next class,” she says.

Eating disorders in children have been associated with depression and anxiety, yet younger kids have a harder time pinpointing emotions or realizing triggers, Tanofsky-Kraff says. She conducts interpersonal therapy with children to help them express their experiences, as it’s often upon reflection that they realize the trigger of an unhappy experience like Enrico’s.

Primary care clinicians could help, too, by asking about eating patterns rather than just noting height and weight, which could help pinpoint LOC eating.

“We can focus on that excessive intake instead of saying, well, just jog an extra mile and eat healthier, which is quite difficult to do. We don’t live in a society that promotes moderation. We live in a society of extremes,” Tanofsky-Kraff says.

Super Heroes: Role Models Help Keep Kids on Track

The best places to begin to teach moderation and healthy eating are in homes and schools, says Lynn James, a Senior Extension Educator at Penn State Extension in Sunbury, PA.

“Children are not going to make good connections or changes if they don’t see the adults around them walking the walk themselves. If healthy food’s not in the home, there’s no chance they’re going to eat it at home,” she says.

The Extension, part of Penn State’s College of Agricultural Sciences, runs many group education programs, including Family Fitness, in which parents attend classes on how to make healthy food choices right along with their kids. Another called Cook Smart, Eat Smart teaches basic food prep and planning to young adults and parents of teens, and Nutrition Links helps low-income families eat well on a budget.

Proud2BMe is a youth outreach project of the National Eating Disorders Association (NEDA) that tackles another big influence on what kids see and hear: the media. Claire Mesko, who runs the project, says that uphill battle is only compounded by social media, which means kids can be bombarded virtually 24/7 by airbrushed images that convey the ideal that only a certain kind of face and body is attractive and only perfection will do. Boys hear about extreme workouts and bulking up.

“There are lot of mixed messages about food body weight and health, and its very difficult to intuitively know how to eat healthfully. Phrases like ‘sinfully delicious’ promote the idea that there are good and bad foods and things to avoid, and that if we indulge we are slipping up,” she says.

Proud2BMe counters with stories and webinars explaining just how images and messages are manipulated, and provides a forum for a lively online community of bloggers and boards where kids can share thoughts or stories of their own struggles with disordered eating. NEDA is also working on public policy to expand mental health coverage for eating disorders.

“We have several states now that have made eating disorders information mandatory for parents, and we would like them to conduct eating disorder screenings right along with BMI tests,” Mesko says.

Join a Great Challenges Google + Hangout Tuesday, May 6 at 12pm ET to talk about disordered eating in children and ways to help keep them healthy through empowerment and effective role modeling.

Case study: From research to web platform, a behavior change program that’s working

As healthcare pays ever-closer attention to programs and research that measure the relationship of patient engagement to outcomes and medical costs, one company has developed a program that delivers the golden egg of behavior change results.

Prevent is a web-based platform by Omada Health that aims to help patients with prediabetes avoid the full-blown disease. It’s a translation of results from the NIH-funded Diabetes Prevention Program (DPP) study, and encourages lifestyle tweaks like exercise and healthier eating. Participants are given a digital scale and join a small online community of some 12 people with of those of similar BMI’s, age and locales for what Cameron Sepah, PhD, Omada’s Medical Director, calls “the dynamic of group therapy in an online experience.” They also undergo an intensive 16-week online training program that includes live health coaching, and move to a maintenance program for the remainder of one year.

The company has published the results of its research study, showing an average weight loss of 5% over the course of a year, and a 0.4% reduction in A1c (a hemoglobin linked to blood sugar levels). Sepah credits the company’s success in great measure to Prevent’s design and user interface. Omada’s team includes former employers from Google, IDEO and Amazon, a fine pedigree.

Secondly, Sepah says, the DPP program – now disseminated nationally by the Centers for Disease Control and Prevention – was well validated from the beginning with its broad and intensive research. Prevent is constructed to closely follow its best practices.

“The [DPP] program itself was very resource intensive and expensive. That’s the challenge in terms of translating to the real world,” he says, adding that to date there have been some 30 translations of it with varying success rates.

In contrast, Prevent has thus far been proven to be cost-effective and accessible to socioeconomically diverse patients. Omada sells it to insurers, employers, and health systems, to whom it guarantees a positive ROI. The company recently closed its Series B funding, raising $23 million to accompany the $4.5 million it raised last year.

Going forward, Omada may venture into management for other conditions in which behavior change modifications are key, Sepah says, such as smoking, insomnia, hypertension or back pain, with the next product rollout slated for 2015.

Which Comes First, A Knockout Biz Plan or the Next Big Thing?

The aptly named Health Tech Hatch (HTH) helps entrepreneurs, many of whom are quite young, fund and test their dream projects. The company offers crowdfunding support and concept testing and feedback. HTH has advised a number of campaigns on Indiegogo.com, one a group of Johns Hopkins undergraduates competing for the Qualcomm Tricorder XPRIZE with a smartphone enabled diagnostic device. Another project is developing a curriculum for a venture classes in health innovation, in pilot with a university in the Midwest, says Patricia Salber, HTH’s founder and CEO.

Web“To date, there haven’t been academic projects that have raised big funding or gone viral, like Scanadu or Lumo Back, so we’re working to help them design a curriculum that they can use to show students how to build a business plan,” she says, adding that all too often entrepreneurs will come late to the realization that even before funding they need to consider building communities, looking for donors and rolling out public relations. Colleges are also adding venture courses to keep those who would drop out and form a company a la Gates & Co. in schools, Salber says.

What are trends in healthcare innovation?

“We’re in the era of validation,” Salber says.

“People have designed all this stuff but we still have relatively little information as to whether it works. Other folks would say it’s all about integration. We’ve built all these silos, but now what we’re seeing is people trying to figure out how to build these into a platform. I just want to look at my steps on a Fitbit platform; I’d really like everything to be in one place,” she says.

“Plus, by and large most health apps aren’t being used. We need to figure out how to really engage people. I think that’s going to happen when physicians start to prescribe apps,” Salber says.

Catalyst is an ongoing series about health innovation, focusing on companies from the TEDMED Hive. For more information about The Hive 2014, click here.


Killing them softly: Andrew Read’s tactics would stop mosquitoes without resistance

Andrew Read is firing some of science’s latest salvos in the fight against malaria, including a resistance-proof green pesticide

Vector-borne diseases (VBDs)  – deadly viruses and bacteria born by mosquitoes, ticks and fleas – have been gloomy landmarks on the pages of human history, particularly after massive scourges like the fifth-century Plague of Justinian wiped out some 25 to 100 million people in the Eastern Roman Empire and heralded the beginning of the Dark Ages in Europe. And #justonebite from a disease-carrying insect, as the World Health Organization (WHO) Twitter campaign for World Health Day reminds us, is all it takes to contract one.

Mosquito eggs hatching in water. Image: Shutterstock
Mosquito eggs hatching in water. Image: Shutterstock

Malaria kills some 627,000 people each year; in 2012, about 460,000 of them are children who died before their fifth birthday – that’s one child death per minute.  Dengue is otherwise known as “bone-break fever,” due to its wracking effects. Chikungunya, a virus spreading rapidly in the Caribbean, brings headache, joint pain and rashes. No wonder just thinking about these gives us the shivers, a fact Bill Gates drove home when he released a jar of mosquitoes into the room at his TED talk in 2009, saying, “Not only poor people should experience this.”

This unsettling move was prescient; we normally think of these diseases as problems only in poor nations like many in Africa, but thanks to globalization and climate changes they’re getting closer to or diving more deeply into the U.S. Someday, West Nile virus, dengue and perhaps Chikungunya may become facts of life here.

Many of these are killers without a cure, so humans have set our wits to defeating them one way or another.  We’ve tried pesticides; environmental control; shields like clothing and bed nets. TEDMED 2012 speaker Andrew Read, biologist and Director of the Center for Infectious Disease Dynamics at Penn State University, has other ideas: He’s attacking viruses where they live, inside a mosquito’s body.

Read is working with Mathew Thomas, a fellow entomologist, to grow a pathogenic fungus that infiltrates a mosquito’s organs, eventually killing it before the malaria parasite it may harbor matures enough to become contagious, a period of about 12 days. The fungus, which shows no harm to humans, can be sprayed on walls, floors and standing water inside a home.

The fungus aims to be an evolution-proof insecticide. Indoor spraying is still a cornerstone of malaria control, but mosquitoes eventually breed resistance to strains of pesticides if they’re killed immediately, and we don’t have that many new chemical options with which to attack them. Plus, killing all of the world’s mosquitoes could have unforeseen ecological consequences. Instead, Read’s formula kills the bugs more slowly, so that the female has time to lay eggs before expiring.

Read has devoted the majority of his career discovering how infectious diseases evolve, particularly the malaria parasite. As he discussed at TEDMED 2012, there are two ways to combat resistance:  a “drugs-bugs” arms race, in which the bugs are already slowly winning; or evolutionary management, trying to shape the bug populations of the future, which which we’ve done a lousy job so far, he says, in part because many scientists don’t fully understand evolutionary biology.

“If we’re really serious, we’ve got to start measuring things, like the selective forces happening when we hit these bugs. We need to think if we can retard or even stop the evolution that undermines our marvelous technology.

“When we attack life, life evolves back. We are picking  a fight with natural selection, and natural selection is one of the most powerful forces in the universe. Going into a fight without Darwin is like going to the moon without Newton,” Read said in his talk.

Nevertheless, his solution hasn’t yet gone to trial. Funding for his efforts and similar ones is scarce, Read says, adding, “Killing bugs is just not sexy.” The global research and development budget is small in proportion to the severity of malaria’s harms. Of that, the vast majority goes toward tinkering with chemical solutions to kill the messengers, while only about 4 percent goes toward actual vector control; that may change, Read says, as resistance continues to build, as it is in some areas, including West Africa.

If diseases in Chikungunya do spread into the U.S., and there is political pressure for a greener, non-chemical solution, ideas like his may gain more traction. One sign:  His colleague Matthew Thomas is working on a fungal agent to kill bedbugs — an idea that’s already received much attention as their numbers grow in the U.S.

Stacy Lu

Happy World Health Day from TEDMED

As an important part of our TEDMED community, we know that you are passionate about creating a healthier world. In the spirit of World Health Day, TEDMED is committed to sharing and convening a global conversation about what is new and important in health and medicine. From September 10-12, 2014, we invite you to bring TEDMED to your home, school or office via TEDMED Live Streaming.

The full stage program will be experienced remotely worldwide via TEDMED Live Streaming in over 100 countries. And remember, TEDMED Live is available free to thousands of medical organizations, academic institutions and government facilities worldwide.

We hope you’ll join us for TEDMED 2014 as we unlock the power of imagination in service of a healthier, more vibrant planet.


In Catalyst this week: Computer-assisted therapy, and an online feasibility facilitator

Mental illness is the single largest cause of disability in developed countries, even more than cancer and heart disease, says the Centers for Disease Control and Prevention. And depression in particular is under-treated in the U.S.; only half of those who suffer get help, particularly some minority groups.

We already use the Internet for countless patient interactions – why not as an adjunct to therapy? Empower Interactive, a TEDMED Hive 2013 company, developed a web-based program, Good Days Ahead, for those who suffer with anxiety, stress or depression.

“There’s a great volume of clinical evidence you can deliver some aspects of psychotherapy by software,” says Eve Phillips, CEO, who explored the potential of the technology while working as a research affiliate in the Synthetic Neurobiology Group at the MIT Media Lab.

Good Days is available in two strengths, so to speak. One is a clinical version to complement talk therapy. Roughly half of a treatment module contains targeted online education, while the other half is work one-on-one with a therapist, who can review information on how the patient is using the system.

The wellbeing version is a self-coping tool that aims to help those with mild symptoms of anxiety and depression. A related mobile app, ReThink, allows users of both platforms to record thoughts and emotions, accompanied by photos, for later reflection. Anonymized, aggregated data gives administrators feedback on user activities and outcomes.

Good Days was co-authored by psychiatrist Aaron Beck, generally considered to be the founder of cognitive-behavioral therapy (CBT). It is a treatment that examines the way that our thoughts and perceptions of situations influence our actions and how we feel emotionally. Research consistently shows that computer-assisted CBT is as effective as standard therapy, and patients using these programs better understand what CBT is and how it works. It’s more cost-effective and easier to disseminate. That’s key in an area like mental health, which is under treated in the U.S. and around the globe. CBT is also helpful for those suffering with chronic pain.

For those reasons and more, Empower has already been working with the United States Army to help enlisted personnel and veterans. They’re also working with Sutter Health and San Francisco Health Plan, and have pilot programs with other major insurers and health systems.

“Some groups are trying to integrate behavioral health into primary care, or do it in a more saleable and consistent way, or perhaps under the umbrella of under chronic disease management,” Phillips says.

Eventually, Phillips hopes to craft a program for kids and teens, too – another under-served population, and certainly one at ease with computer screens.

Building A Global Research Superhighway

“LinkedIn on steroids” is how Dr. Fabio Thiers, founder and CEO of The Hive 2013 company ViS Research, describes the web platform that helps trial planners to find investigators and sign up the perfect research center. An analytics-slash-communications tool, ViS helps planners source and sort investigators by capabilities, expertise, current trials and available patient populations, and then contact them on the closed system. Currently, some 330,000 investigators from 178 countries are represented on the system, comprising 417,000 disease-specific centers.  The data is visualized according to location.