Professor Phillipa Hay is a psychiatrist and the current Chair of Mental Health at Western Sydney University in Australia, the co editor-in-chief of the Journal of Eating Disorders, and past recipient of the Lifetime Leadership Award from the Australia New Zealand Academy for Eating Disorders. Drawing on her experience from decades of teaching, research, and clinical care in eating disorders, Dr. Hay discusses the limitations of weight-based criteria in eating disorder diagnostic criteria, both in terms of limiting treatment access and in restricting our understanding of recovery. 

Today we have the good fortune to hear from Dr. Kelly Klump whose contributions to the field of eating disorders are indeed invaluable. Inspired by one of her early mentors, Professor Gloria Leon, Dr. Klump has embarked on a journey of groundbreaking research that reshapes our understanding of the complex interplay between genetics, hormones, and environmental factors in the development of eating disorders. Dr. Klump’s exploration of gonadal hormones, including estrogen, progesterone, and testosterone, is steadily uncovering the relationship of hormonal fluctuations, particularly during puberty, to the onset and expression of eating disorders. Translating these findings to clinical practice has the potential to inform more effective prevention strategies and personalized interventions for individuals at risk of developing eating disorders.

In this episode, we delve into the insights of Trinity University Psychology Professor Carolyn Becker, whose insatiable curiosity and openness to explore diverse fields have been the driving forces behind her innovative and fruitful career. Recognized for her excellence in teaching and research, Professor Becker's expertise lies in implementing scientifically backed interventions in both clinical and real-world contexts. She has led innovative work focused on body image and athletes and has spearheaded groundbreaking research on eating disorders among individuals facing food insecurity, a demographic often overlooked by conventional eating disorder studies. Her work underscores the imperative to dismantle stereotypes surrounding eating disorders.

Today’s episode takes us on a global journey with Dr. Anne Becker, Maude and Lillian Presley Professor of Global Health and Social Medicine at Harvard Medical School. Although Anne never became the meteorologist she imagined in her youth, as a psychiatrist and anthropologist, she traveled far from home to launch pioneering work in Fiji focused on how culture contributes to shaping the meaning of body image and risk for eating disorders. In this episode, Anne shares how she got to Fiji, the surprising conversations, and the evolving meaning of weight in Fijian communities at different points in time. Anne shares the serendipitous circumstances that enabled her to map the impact of the arrival of American television on triggering eating disorder symptoms and rising body shape and weight concerns. Dr. Becker’s keen intellect and her delight in discovery is riveting and contagious as she shares her pioneering work, which is foundational for anyone who wants to understand culture and eating disorders.

Becker, A.E. Television, Disordered Eating, and Young Women in Fiji: Negotiating Body Image and Identity during Rapid Social Change. Cult Med Psychiatry 28, 533–559 (2004). https://doi.org/10.1007/s11013-004-1067-5

Becker, A.E. Body, Self, and Society: The View from Fiji, 1995.

We are thrilled to be joined today by Dr. Paul Appelbaum for the last of episode in our special series focused on the proposed diagnosis of “terminal anorexia nervosa.” Dr. Appelbaum is the Elizabeth K Dollard Professor of Psychiatry, Medicine, and Law at Columbia University and Past President of the American Psychiatric Association, the American Academy of Psychiatry and the Law, and the Massachusetts Psychiatric Society. A member of the Institute of Medicine of the National Academy of Sciences, Dr. Applebaum has received numerous awards for his extraordinary contribution to forensic psychiatry, psychiatric aspects of jurisprudence, clinical trial ethics, capacity assessments, and medical aid in dying. Dr. Appelbaum brings a depth of experience and particular expertise to our discussion of “terminal anorexia nervosa” and the use medical aid in dying in psychiatry more broadly.

I am delighted to be joined today by Rachel Rattenni as part of our special series focused on the proposed diagnosis “terminal anorexia nervosa.” Rachel has a graduate degree in bioethics from Columbia University and is currently pursuing a master’s in public health at Johns Hopkins University Bloomberg School of Public Health.  She also serves as Rachel serves as the Program Assistant for Big Ideas In Eating Disorders. Her formal studies and work, in combination with her own lived experience with an eating disorder, inform her thoughtful and insightful comments on the risk of losing hope associated with the proposed diagnosis and the need to create more space for patients to have voice and agency in shaping their treatment goals, i.e., from the beginning and long before they meet the proposed criteria for “terminal anorexia nervosa.”

Today's episode of Big Ideas in Eating Disorders is part of a special series delving into the proposed diagnosis of "Terminal Anorexia Nervosa." I am honored to have Dr. Eric van Furth, a clinical psychologist and Professor of Eating Disorders in the Department of Psychiatry at Leiden University Medical Center, as our guest. With decades of experience in the eating disorder field, Dr. van Furth has received numerous awards and accolades, including a Leadership Award from the Academy for Eating Disorders and the Project HEAL Clinician of the Year Award.

Dr. Van Furth’s research has contributed extensively to increasing our understanding of effective treatments and improving treatment outcomes for people with anorexia nervosa. Hailing from the Netherlands, a country with universal healthcare and where Medical Aid in Dying (MAID) is available for individuals with psychiatric disorders, his unique perspective enriches our ongoing dialogue about anorexia nervosa, its terminology, and the current discussions surrounding the proposed diagnosis of “Terminal Anorexia Nervosa.”

The current episode is the third of our six-part series focused on the proposed diagnosis of “terminal anorexia nervosa.” My guest is Rosiel Elwyn (they/them/she), a PhD candidate at the Thompson Institute, Australia, who is studying the neurobiology of anorexia nervosa with a focus on the role of trauma and its effects on the glutamatergic system, the gut microbiome, and interoceptive function. Rosiel has lived with anorexia nervosa since childhood and currently works as a lived experience researcher and mental health consultant on a number of projects and advisory groups in eating disorders, suicide prevention, psychosis, trauma, and trauma-informed care, with a particular interest in co-design in these areas. With heart and mind, Rosiel shares with us hard earned insights on the proposed diagnosis of “terminal anorexia nervosa” and demonstrates brilliantly the unique and essential contributions that people with lived experience bring to field of eating disorders.

Elwyn, R. A lived experience response to the proposed diagnosis of terminal anorexia nervosa: learning from iatrogenic harm, ambivalence and enduring hope. J Eat Disord 11, 2 (2023). https://doi.org/10.1186/s40337-022-00729-0

Treem, J., Yager, J., Guadiani, J.L. AMA J Ethics. 2023;25(9):E703-709. doi: 10.1001/amajethics.2023.703

Joining the podcast is Dr. Angela Guarda, the Stephen and Jean Robinson Professor of Eating Disorders in the Department of Psychiatry and Behavioral Sciences at the Johns Hopkins School of Medicine and Director of their Eating Disorders Program since 1997. This is the second episode in a six-part series that revolves around Guadiani, Bogetz, and Yager's suggested diagnosis of "Terminal Anorexia Nervosa." In our conversation, Dr. Guarda reflects on her decades of clinical and research expertise and provides a thoughtful and impassioned response to this complicated and provocative proposal. I have reflected many times on our conversation since its recording. Consummate educator, Dr. Guarda has much to teach us.

Guarda AS, Hanson A, Mehler P, Westmoreland P. Terminal anorexia nervosa is a dangerous term: it cannot, and should not, be defined. J Eat Disord. 2022 Jun 7;10(1):79. doi: 10.1186/s40337-022-00599-6.

Gaudiani, J.L., Bogetz, A. & Yager, J. Terminal anorexia nervosa: three cases and proposed clinical characteristics. J Eat Disord 10, 23 (2022). https://doi.org/10.1186/s40337-022-00548-3

This marks the beginning of a six-part series centered around the proposed diagnosis of "Terminal Anorexia Nervosa." In this inaugural episode, I talk with Dr. Joel Yager, Professor Emeritus of Psychiatry at the University of Colorado School of Medicine. Dr. Yager, alongside co-authors Dr. Jennifer Guadiani and Alyssa Bogetz, an individual with Anorexia Nervosa who passed away before the article's publication, proposed the criteria for “Terminal Anorexia Nervosa” in the paper linked below.

With decades of experience in the eating disorder field, Dr. Yager served as the Director of the Eating Disorders Clinic at UCLA from 1981 to 1988. His contributions have earned him numerous awards, including the Lifetime Achievement Award from the National Eating Disorders Association, the Special Presidential Commendation, and the Distinguished Service Award from the American Psychiatric Association, along with a Lifetime Achievement Award from the Colorado Psychiatric Society.

Drawing from his extensive expertise, Dr. Yager articulates why he believes it is crucial for the field to grapple with and refine the proposed diagnosis of "Terminal Anorexia Nervosa." This proposal has ignited a robust conversation and debate among a diverse range of stakeholders. In the upcoming episodes, we will hear perspectives from American and European colleagues, a biomedical ethicist, and individuals with lived experiences -  all sharing their varied views on this highly controversial topic.

Gaudiani, J.L., Bogetz, A. & Yager, J. Terminal anorexia nervosa: three cases and proposed clinical characteristics. J Eat Disord 10, 23 (2022). https://doi.org/10.1186/s40337-022-00548-3

Be sure to subscribe so you do not miss additional episodes in this series as they are released over the coming weeks. Check out our website for more information: bigideasineatingdisorders.com