As the 2019 National Eating Disorder Awareness Week comes to a close, we the advocates, organizations, medical professionals, counselors, and parents must aspire to far greater accomplishments and strive to accomplish goals deemed impossible just a few short years ago.

As the standard bearers we surely must be, we must embrace the incredible challenge before us. We must recognize and confront the corruption, fraud, ego and arrogance which threaten the very foundations of our community and which weaken our collective voices.

We must look, not within, but outside and explore new sources of inspiration and resources, be they political, or business, or foundational or financial. We must set aside petty differences. We must use our successes in the past, not in a manner which defines who we are and which inevitably leads to complacency, but as a springboard to a greater future and challenges us to continue to learn, to grow, to expand our horizons.

We must have our doctors, our scientists, our leaders in research and study collaborate, to share knowledge, information and material which can lead to one thing and one thing only … breakthroughs in the understanding and treatment of this deadly disease.

This past week, we celebrated our accomplishments. We raised some money. We recognized the survivors. We appeared on television shows and in podcasts. And yet, surely more is expected of us. More is demanded of us. And we must not fail.

The honored dead claimed by this disease expect and demand more. The Army of Warrior Angels is restless. We must be resolute. We must be strong. We must not quit. For if we do, we will surely lose ourselves, our very souls. And that is not an option.

To honor those who have been taken, and to remind us all what we must fight for … We leave you this. And our future beckons.

The Morgan Foundation … Let the Past Inspire Our Future

“Well, here at last, dear friends, on the shores of the Sea comes the end of our fellowship in Middle-earth. Go in peace! I will not say: do not weep; for not all tears are an evil.”

J.R.R. Tolkien, “The Lord of the Rings”

On March 12, 2018, the North Texas eating disorder community said a tearful good-bye to the eating disorder program at Texas Health – Presbyterian Hospital. Presby announced that it was discontinuing and closing its eating disorder program after being in existence for over 20 years.  Presby is a not-for-profit hospital and accepted Medicaid, Medicare and Tri-Care.  However, it is well known that these government-subsidized insurance programs do not pay sufficiently to sustain an eating disorder program and without sufficient, additional financial resources, this valuable member of the community closed.

As we close out “National Eating Disorder Awareness Week,” we had to say Auf Wiedersehen to another long-standing eating disorder stalwart in the North Texas community. This time, Renfrew Center of Dallas announced it was closing. [Note that it is only the Renfrew Center of Dallas closing and not its other locations]. In 2016, Renfrew celebrated its 30^th year in business under the steady hand of its Founder and President, Sam Menaged. Renfrew Dallas was located on the first floor of an office building in North Dallas from where it conducted its eating disorder treatment, IOP and counseling programs. In the last few years, it counted Kiersten Rapstein and Sharon Watts as two of its key employees. There are very few people in the eating disorder industry whom I respect more than Ms. Rapstein and Ms. Watts. They led the program with strength, humor and gentle grace. And Renfrew Dallas will be missed.

I understand that Renfrew has been proactive in finding positions for employees. Ms. Watts is still retained in a business development capacity. Ms. Rapstein is running a virtual therapist led outpatient support group for Renfrew. And Renfrew Dallas will be missed.

So, to them, we say, “Auf Wiedersehen” which in German does not mean good-bye, but “Until We Meet Again.” We hope to see you in North Texas again some day Sam. You are needed.

Keep Your Resume Updated

Most people have heard of the phrase, “When God closes a door, He opens a window.” Well sometimes, when God closes a door the window that is opened leads straight to the sub-basement.

With that, we acknowledge that the Eating Disorder Solutions treatment center (“EDS”) is attempting to open in Dallas, Texas.

EDS is owned by Niznik Behavioral Health based out of Miami Gardens, Florida. To begin our review of EDS, let us first go to their website, eatingdisordersolutions.com. At first glance, to say their home page looks rather parochial would be charitable. Nonetheless, upon scrolling down the page, we see the very recognizable gold seal designating that EDS has been accredited by the Joint Commission! Good for them. That is very commendable to obtain such recognition even before its residential home is even open for business. But wait …

Anyone can verify accreditation by the Joint Commission by simply going to qualitycheck.org. And upon doing so, and typing in the name “Eating Disorder Solutions,” 24 separate entities appear in the State of Texas. And strangely enough, NONE pertain to EDS. So, then when one does a search on Niznik, a number of different entities appear. And some of them are accredited by the Joint Commission. And yet again, strangely enough, none of these accredited entities is EDS. A search of Niznik on LinkedIn reveals the following representation: “All NBH facilities are fully accredited by the Joint Commission and collectively offer the full continuum of care for our clients.” Well, not so fast my friends.

Dear Niznik d/b/a Eating Disorder Solutions … EDS is in fact NOT accredited by the Joint Commission. You are making material misrepresentations of a material fact to the general public! You are using accreditation on your website that you do not have and that you are not entitled to use to falsely misrepresent your credentials. Your violations of the Texas Deceptive Trade Practice Act are open and notorious … and yet, we are just beginning.

On its homepage, EDS has a scrolling five (5) picture montage of a house in Dallas, Texas purporting to be its “residential treatment” house. This house is located in Northeast Dallas in a strictly residential area. When Niznik purchased the house, it was being used as a senior citizens residential group home. Again, the area in that part of Dallas is zoned as residential only. Next to hospitalization, a residential treatment facility is the highest, most intensive treatment regiment available for a person suffering from an eating disorder. It entails medical monitoring. It requires the attention of a medical doctor and/or psychiatrist to monitor and assist the patient suffering from eating disorders. Daily individual counseling. Group counseling. Blood testing. Medical services being administered. A patient’s life hangs in the balance. Strict requirements over access to bathrooms, kitchens, access to rooms must be enforced. And EDS has? None of these things in this senior citizens home. No controlled locks on the bathroom doors. No oversight over the kitchen. No medical staff living in this “residential” home.

Niznik bought a home. A home in a residential area of Dallas. And they are naively hoping that no one will take notice and object to their bastardization of the zoning laws. And yet, their incredulous arrogance does not end there. According to anonymous sources:

EDS does not employ a psychiatrist on a full time or part time basis.

EDS does not employ a medical doctor on a full time or part time basis.

EDS does not employ any certified eating disorder specialists on staff.

ESD employs a therapist and a dietician. That is it.

When you review EDS’s website, it lists ZERO, NADA, NO medical professionals. It does not list any counselors. No doctors. No nurses. No certified eating disorder specialists. No staff at all. And that is because, they have no doctors, no certified eating disorder specialists on staff. And yet, on its website, it states: “Under clinical supervision and with the guidance of experienced and certified eating disorder specialists, our clients gain the knowledge and tools necessary to redress harmful thought and behavioral patterns regain control of one’s eating habits.”

First, YOU DO NOT EMPLOY ANY CERTIFIED EATING DISORDER SPECIALISTS! Second, the people whose lives are entrusted to your care are not CLIENTS. They are patients. They are people suffering from a mental disease that has the highest mortality rate of all mental illnesses. These tortured souls are NOT clients! They are patients. And they are suffering. They are not assets upon which you can rely to make money.

EDS is owned by Niznik Behavioral Healthcare. The entity is named after Robert Niznik. In 2018, the United States Congress, through the House Committee on Energy and Commerce turned its attention to the substance abuse industry. One of the main purposes of this subcommittee was to investigate the predatory marketing and advertising practices in the substance abuse industry. This subcommittee cited the realization that there were many “bad actors” who preyed upon vulnerable families and addicts. Robert Niznik was called upon to testify before Congress about his company’s illicit marketing and advertising practices.

EDS also relies upon Eric Brandman as the Chief Marketing Officer for Niznik Behavioral Health. Mr. Brandman is a 26 year old boy. In 2013, he received his Bachelor of Arts in Financial Mathematics from Baruch College. [I will buy a martini for those who can, without any research, enlighten us as to where and what a Baruch College may be.] On the other hand, he does list that he was Treasurer of the Handball Club! When the Mental Health Parity Act of 2008 was passed, Mr. Brandman was a sophomore in high school. On the other hand, on his LinkedIn profile, Mr. Brandman lists under his Skills and Endorsements, “Microsoft Excel, Microsoft Word and … Powerpoint! Who would not entrust their child suffering from this insidious disease to a person barely out of puberty who collected two dollar apiece from his fellow handball aficionados?

When you call their toll-free line and are seeking help for your loved one who is suffering, you must talk with one of their marketing employees. You will first be asked about how you can pay for treatment. Can you pay cash? That is because they are not in-network with any insurance company! But, they do know that for residential treatment in their illegal residential home, they can try to charge up to $30,000 per month if they are successful in obtaining a single case agreement. (Assuming they even know what that is.)

To call this entity aggressive and predatory would be underestimating the reality of this operation. EDS represents everything wrong with the eating disorder industry. It represents the absolute worst that can happen in an unregulated industry. And while reputable, experienced entities like Renfrew Dallas are forced to shutter its doors, assclowns like EDS rear its ugly head.

Messrs. Niznik and Brandman, just know this … pray, to whatever God to whom you may pray, that your predatory practices do not harm even one family suffering from eating disorders. For if you hurt one person … one family, if you worsen one person’s life, if you harm one person suffering from this insidious disease … and they find me, I will be relentless. I will hunt you in the court system. I have 35 years of courtroom experience. Messrs. Niznik and Brandman, I was obtaining justice in the courts of the United States 10 years before you were even born. And I will never stop.

I will be coming for you. And an Army of Warrior Angels will be coming with me.

“We live in a culture where everyone’s opinion, view, and assessment of situations and people spill across social media, a lot of it anonymously, much of it shaped by mindless meanness and ignorance.”

     Mike Barnicle, Print and Broadcast Journalist

“By giving us the opinions of the uneducated, journalism keeps us in touch with the ignorance of the community.”

     Oscar Wilde, Author

Eating Disorder Awareness Week is once again upon us. That week when walks are held, buildings are lit in the blue and green colors chosen by the National Eating Disorder Association. Lunches will be held. Speeches will be given. Some people will appear before the clerks of Legislators and will tell their story. Maybe some movies or documentaries will be shown. And for many, we will feel good about ourselves believing we are making a difference. We will pat ourselves on the back and then go back to business as usual.

And if we believe the statistics, during this week, another 162 lives will be snuffed out by this insidious disease. 162 people who will never again see a sunset, or feel the gentle caress of a loved one, or smell freshly cut grass in the spring time, or wake up with hopes that today will surely be better. 162 souls.

And all the while, society for the most part will continue to not notice. On Friday, February 22, 2019, the local Dallas/Fort Worth CBS affiliate aired a story on Manda Welch. Manda has been struggling with eating disorders most of her life. It was an insightful story and included the manner in which social media interacts with eating disorders. The video appears at the end of the article.

If that were the end of the story, most of us would applaud the story and then move on with our lives. Sadly, it is not. On the CBS DFW page on Facebook, immediately after the story was aired, the comments from viewers began to pour in. The following are those comments. The names and messages have not been changed to protect the ignorant:

• Lisa Maciuba  She gave up chocolate milk and croutons at the age of 6….BECAUSE SOOO MANY 6 YEAR OLDS LOVE CROUTONS!!! WTF???

Tara Hood My six year old eats a ton of croutons!! 😂

Lisa Maciuba Tara Hood that’s something I wouldn’t even think about

Dennis Monares I loved eating croutons at 6, 41 years later and I still eat them.

Lisa Maciuba Dennis Monares I was more into sweet tarts and novelty candy!

Jo Richardson Social media hasn’t made anyone do anything

Christina Dixon Jo Richardson right. Just as many food ads, guess I can blame them for this extra 30 pounds I’m carrying? 👎

Jo Richardson Christina Dixon C,I hear ya

Dennis Monares Social Media makes me laugh.

Kyle Jones Jo Richardson it made me fat…and Chinese.

Brandon Collins Quit blaming other people for your issues

Shaz Uddin Jimmyjohns.com

JIMMYJOHNS.COM

Home | Jimmy John’s Gourmet Sandwiches

Home | Jimmy John’s Gourmet Sandwiches

Jeff Scott So her mental illness is somehow social media’s fault. I don’t think so. Sorry, her mental illness. Her problem.

Deb Kirksey Alexander So they want Big Brother watching 🤔Grow up take responsibility for yourself/friends. It’s not social media business 🙄

Victor Guerrero Just eat and shut up …lol

Jim White Disorder ≠ disease

RW Singley You mean like stop posting her pictures?😵

Macias Cesar Montoya Gtfo

Crystal Mougier Du Plessis Get the hell off of social media if it’s affecting you that badly and you can’t mentally handle what you are seeing…problem solved 🤷‍♀️ …. you don’t need to be part of social media… so stop using it…

Krista Davis Okkkkk where were her parents while she was in MIDDLE SCHOOL and not eating for a week….

Katherine Welch Krista Davis her parents were naïve and didn’t notice because they were busy with their own addiction.

Wesley Becknal Hahaha people like this are stupid and have a head problem. Pretty sure you weren’t a regular on social media at 6 years old.

Katherine Welch Wesley Becknal first of all I would like to just say you sound very ignorant! You shouldn’t call anyone with any kind of mental health issue stupid! I prayed you or anyone in your family ever suffers from one! Obviously she didn’t say she was using social media at the age of 6! What she said was this started at the age of 6!

Michael Reppond Absolutely right

Dell Stevens Prayers

Ryan Henderson Because it’s social media’s fault you have body image issues……

Misticious Twixx Daniels Ummmm whatttt?

Scott Boyd She needs to logout… while driving to seek professional help.. she needs to grab a burger and some tacos…

Fred Lee Knight You can’t protect someone from themselves.
You have a right to screw up your life how you choose

Joseph Esqueda What happened to personal responsibility?

Anthony Lewis It’s Trump and Obama’s fault. Did I leave anyone out?

Constance Chitman-Cage I have disordered eating. (EDNOS) So i get what she’s saying but it’s no ones fault what’s going on inside your own head. Trust me I’ve been dealing with this for a long time. Well before social media.
Just log off. That simple. If it’s making you feel some kinda way, walk away.

Cathy Gentry It’s not a dam disease it’s a choice like being alcoholic or dope head no disease choice

Cylena Morris-Smith Don’t join social media.

Estefana Chavez Don’t blame social media, see a real doctor

Justin Ward Wafflehouse.com

Floyd R Robinson Stated at 6 years old? She should be calling out her parents.

Debby Kastigar It’s always someone else’s fault.

Mandy Alsop log off. that simple

Austins Ossai NO THEY DO NOT

Zo Lopez She needs to hang around her Mexican friends she’ll be be fat by the summer.

The ignorance spewed forth by these people “span the globe.” Parents were blamed. Fingers were pointed. Suggestions to see a “real doctor.” Don’t blame social media! Anorexia is a choice not a real disease. Promulgating the stereotypical behavior of Hispanics. Baseless hostility. Cruel remarks meant to pass as humor one supposes.

And the ignorance came forth equally from African-Americans, Anglo-Americans, Hispanics, and men and women of all ages.

It would be very easy to simply blame this diatribe of short sighted, uninformed pablum on those who are not educated about, do not understand or refuse to grasp the deadly nature of this disease. Perhaps that has always been the case and those people have always existed. In 1830, Victorian author and playwright, Edward Bulwer-Lytton referred to people of that ilk as, “the Great Unwashed.” The only difference seems to be that now the internet and social media allow anyone to parade their ignorance in full public view for all to see.

But, it is more than that. The issue also lies elsewhere. Perhaps the issue lies at our doorstep. Perhaps it lies at the feet of us, those in the eating disorder industry and community. We speak of increasing eating disorder awareness. And yet, we tend to stay in the same, comfortable circles. We solicit money from the same financial resources. The only people who attend seminars or education classes are those in the eating disorder industry. We hold our “fun walks,” and for the most part, the only people who attend are those who have suffered from this disease, their friends and treating professionals. And the myth of “the rich, little white girl’s disease” lingers and permeates mainstream society.

The federal government ignores us. The state governments ignore us. We lobby on bills that are designed to help the private equity owned residential treatment centers in the industry while ignoring mainstream public knowledge. And our children continue to die.

So, this next week, as we pat ourselves on the back, as we hold ourselves out as doing great and mighty things, perhaps we should again read the messages and comments above. That is not just mainstream America but it is prevalent on a worldwide basis. Those people are part of our current legacy. And during Eating Disorder Awareness Week, 162 more souls will be taken. 162 families will be shattered.

And we must ask ourselves, have we in fact, failed in our messaging? A great opportunity lies before us. We have the opportunity to take the poor, huddled masses, those who would otherwise not come to us and tell them “Come as you aren’t!” We can help you. We can guide you to a more soulful enlightenment.”

162 souls.

For the sake of those 162 and the millions in that Army of Warrior Angels, we must embrace that opportunity to reach out to those who live in ignorance of this disease and tell them  “Come to Us as You Aren’t!”

Anorexia Survivor Calls Out Social Media Companies For Not Doing More To Stop People From Promoting Starvation

“Our greatest glory is not in never falling, but in rising up every time we fall.”

            Ralph Waldo Emerson, Author

“Character cannot be developed in ease and quiet. Only through experience of trial and suffering can the soul be strengthened, ambition inspired, and success achieved.”

          Helen Keller

Forty years ago, cancer was that dirty little secret never discussed in polite company. It may have been heard in whispered conversations. And, when it was discussed, more often than not the topic involved how cancer had claimed another life. Today, cancer is discussed openly. And when we discuss cancer, more often than not, the topic is how a person “beat” cancer, how they are not just a survivor, but are thriving. Stories of strength and inspiration.

Some attribute that change in attitude and perception in part to that stirring, inspirational speech given by former North Carolina State basketball coach, Jim Valvano in March 1993 when he was in the grip of cancer. His talk on an ESPN Awards Show kick started the Jimmy V Foundation for Cancer Research and its motto, “Don’t Give Up, Don’t Ever Give Up,” became a message of hope for those suffering from cancer.

Today, mental illness, particularly eating disorders is that “dirty little family secret” not talked about in polite company. Shame casts a dark pall over it. It is not talked about at dinner parties and when discussed, it is usually to mourn the loss of a loved one. And yet, success stories do exist.

Kristina Saffron and Liana Rosenman met while in treatment. As part of their recovery journey, they started Project HEAL. They are building Project HEAL into an industry giant as it is rapidly becoming an expanding, powerful entity in the eating disorder industry.

Brian Cuban is another inspirational story of recovery and redemption. From an early life of bulimia to alcohol and cocaine addiction, Brian now leads a life of sobriety, is a respected author and speaker and inspires so many through his stories of hope and resiliency.

Then there are the many others who do not seek, nor receive the spotlight. Their stories too would undoubtedly inspire and give courage, hope and strength to those who still suffer from this insidious disease. And as such, with their permission, I am going to briefly highlight two of these Warriors.

Manda Welch

I first met Manda Welch in April 2017 at an event the Morgan Foundation organized called, “Night with the Experts.” Dr. Stephanie Setliff of ERC Plano, Dr. Carrie McAdams of UT Southwestern and Dr. Dana Rubin-Remer of Girls to Women Health and Wellness Clinic appeared for two hours to speak to a crowd of people discussing eating disorders.

A frail, young woman sat in the front row, her leg tapping up and down in a way indicating anxiety, fear or simply not being aware of her own body. We spoke of my daughter Morgan. Manda indicated she was still struggling. Being in the midst of depression over my daughter being taken, I tried to talk of inspiration, strength and hope. But, even to my own ears, my words sounded hollow.

Manda and I kept in touch on Facebook through messaging. She was very open about her on-going struggles. And then, heroin entered her life and I grieved, fearing that these two demons combined would surely take her life. She would drop off of social media for awhile and then resurface. She applied for a scholarship to pay for treatment from Project HEAL. She applied for Medicaid and was denied. She lost her employment and unemployment benefits were denied. She finally checked herself into a detox clinic operated by the State of Texas.

Months elapsed. Then, fate brought us back together. Manda was going to be featured on a news story to be broadcast by the local CBS affiliate in Dallas/Fort Worth. This was being filmed at the offices of a very dear friend, Patti Geolat and the Something for Kelly Foundation. I showed up and was overjoyed to see Manda was the subject of this news story. And for the first time, I saw “life” in her eyes. And tears in mine.

We naturally hugged and Manda filled me in on her life. After surviving a heroin overdose, the fog was lifted from her. She has now been sober for fourteen (14) months. Her eating disorder demons were under control. And although there may be the occasional rare lapse, her life of sobriety and personal insight has put the demon back into the cage. She is employed and has a strong support group around her on a daily basis. And she has a future.

The Channel 11 news story happened and will be the subject of my next posting.

Most people in the eating disorder industry will never meet nor even know Manda. But Manda, survived and is beginning to thrive. The industry talks about people and that they can beat this disease. We know of those persons when they write books, or go on speaking tours or become spokespersons. And surely, society needs those people to put a “face” on this disease. But for every one of them, there are thousands of Mandas. A young woman who struggled. Whose life was almost claimed. Who survived. And for those of us who know her, we are inspired by her courage and perseverance.

Ariana Max

Ariana Max is a young woman residing in Houston, Texas. She found the Morgan Foundation through social media and reached out to me. When Ariana found me, I felt and feared that she was near the end of her rope.

She had been in a number of treatment centers. She left some. She was asked to leave others. None resonated with her recovery. Her physical health continued to deteriorate. Finally, when she was receiving treatment in Oklahoma, her body betrayed her. Her condition became dangerously acute and she was care flighted to the Children’s Hospital at the University of Oklahoma Medical Center. After partially stabilizing, she was discharged although still in a precarious medical condition.

She was fearful of emergency rooms, of being over-hydrated and having her electrolytes become unstable again. Her weight plummeted to the lowest in years, her insurance had lapsed and she could only afford to pay for one, 45 minute counseling session every week. She explored holistic options, acupuncture and polychromatic light therapy treatments. The world seemed dark and the demon was winning its fatal, dark game.

She had a falling out with her therapist and even her family felt hopeless. And then, just like Manda, she awoke from her fog.

She wrote these powerful words to me: “My body has defied science for 12 years, and it’s define science and logic right now. This is a sign for me that I am obviously here for a reason, and I do not want to waste that. I honestly feel like I am here for a reason. My body has defied science for 12 years, and it’s defining science and logic right now. This is a sign for me that I am obviously here for a reason, and I do not want to waste that. I spent a lot of time over the last several weeks putting the pieces to my puzzle together, and although it’s been very difficult as I do most of that on my own as I cannot afford the appropriate therapy, I am finding that I can be powerful and my voice does matter. I truly believe that I hold a very important key and it took all of the suffering and pain to figure it out.”

“I am Ariana and Ariana matters and I’m not going to stop fighting for that. I am done being told I can’t, I’m done being told people do not believe in me. I am done being defined by mental illness. I’m Ariana and Ariana matters and I’m not going to stop fighting for that. At this point I’m willing to get up in front of millions of people and tell my story because I truly believe it needs to be heard. I cannot stay silent on an issue anymore that is affecting so many people in this country that is killing so many innocent souls.”

Some time went by and then, she again contacted me. And what I saw overwhelmed me. She had found … salvation? She was physically, mentally and emotionally strong. She had found her voice and her voice had found her. On Facebook she posted photos of her doing one-handed, hand stands, walking on her hands, exhibiting strength, poise and grace. And she had rediscovered her gift of art. She custom paints jackets, jeans, artwork. If you go to a website featuring her recovery and art, you will see that strength, that creativity, that passion of the soul.

Ariana Max Art Website

We are Lifted Up

Both Manda and Ariana have told me that I am a “hero” to them, that I inspire them. To them and everyone, I say, I am no hero. I am an incredibly flawed man whose heart was ripped away. Yes, I have a gift of being able to use words reasonably well. But, Manda, Ariana and all of the silent Army of Survivors in our midst, YOU are the true heroes. YOU inspire me. YOU inspire those doctors, counselors and dieticians toiling in the industry. YOUR heroic victory over pain, over anguish, over almost losing your very soul is what the eating disorder industry is really about.

Manda and Ariana, you are our true Heroes! And it is heroes like you, and the Army of Survivors, who inspire us to continue working, to continue pushing, to continue to change the status quo which can only lead to a better tomorrow.

Manda and Ariana, you make it possible for us to continue to “Save Lives … One Precious Life at a Time.”

Heartfelt congratulations should go to The National Health and Medical Research Council in Sydney Australia (“NHMRC”). The impending announced research study funded by the NHMRC and to be conducted by researchers at two major Children’s Hospitals in Australia is already incredibly successful, not just on a national scale in Australia, but internationally as well. And for this, the doctors and medical professionals who will be participating in the study should be lauded.

But, it is not for the reasons those medical professionals may believe.

In the eating disorder industry, it is very rare, perhaps non-existent for the vast majority of players (organizations, doctors, counselors, dieticians, advocates, families) to “circle the wagons,” to unite and speak with one clear, unambiguous voice on any issue, let alone an issue that may be regarded as controversial. Silo mentality in the eating disorder industry is prevalent. The race to become the next Jonas Salk permeates the industry. And so, the thought that a single issue could arise which would unite all factions seemed unlikely at best.

No longer.

The international eating disorder community became aware of the aforementioned research study to be conducted by the NHMRC. This twelve (12) month study is to be performed on children from the ages of 13 years to 17 years of age who are classified as “well above a healthy weight.”

The Study requires the children to follow extreme calorie restriction diets (800 calories per day) for one month, and not in a laboratory or carefully controlled setting. This is to be followed by 12 months of low calorie dieting for half the participants, and alternate day fasting for the other half. Children in the fasting group will eat just 600–700 calories a day for three days a week, approximately 25–35 per cent of estimated daily energy needs. The remaining four days will be a “standard diet.”

These children and their parents will be required to closely monitor the children’s daily food intake not only at home but at school as well to make sure that the exact amount of caloric intake is strictly followed. Nothing like pristine laboratory conditions capable of being duplicated in future studies!

The outcry from the eating disorder community started as a whisper, became a loud talking point and has now escalated to become a mighty roar. Counselors, doctors, dietitians, organizations and advocates in Australia and New Zealand began to communicate, collaborate, review the published proposed trial study and organize a unified response. Clinical psychologist Louise Adams organized industry replies to this ill-advised research study. Her blog article can be found here: https://untrapped.com.au/lets-not-spend-1-2-million-starve-teenagers/

The preeminent eating disorder foundation in Australia, The Butterfly Foundation, in conjunction with the Australia & New Zealand Academy for Eating Disorders, Eating Disorders Victoria, and Eating Disorders Queensland issued a joint release stating in part:

“Eating disorders are complex neuropsychiatric illnesses with severe mental and physical implications. Given such, we still have concerns and believe further action is required.

In discussion with the principal researchers involved in the trial, we have requested the following:

• The risks of developing an eating disorder are clearly stated in the participant and parent information sheets, and on the trial website;
• Additional psychological support for participants throughout the trial;
• Additional screening for anxiety and distress at key points during the trial;
• Specific training in Eating Disorders for all clinicians involved with participants.”

In a separate statement, the Australia & New Zealand Academy for Eating Disorders in material part stated:

“The risks of developing an eating disorder were reportedly deemed to be justified on the basis of likely benefits of the trial and the inclusion of a risk management plan that would minimise risks and communicate risks associated with potential eating disorder development to participants and their parents/guardians. ANZAED is highly concerned about this justification. Eating disorders have the highest mortality rate of any mental illness, with onset common during adolescence. With consideration of these points, it is ANZAED’s position that the risk of developing an eating disorder is not warranted in this or any other research trial. …

As a result of careful consideration of the points raised above, ANZAED does not support this trial of an extremely low calorie weight loss intervention in adolescents.”

A petition condemning the study and demanding that it be stopped has now reached over 16,000 signatures worldwide and continues to increase every day.

Last week, doctors, counselors and advocates drafted and submitted a collaborative ethics complaint to the study. A copy of this report is attached at the end of this article. Some of the more significant statements include:

“Because the trial places participants in a prolonged state of calorie restriction, the risk of bulimic episodes is considerably heightened. Calorie restriction is a known primary trigger for hyperphagia (often termed binge eating), and is often accompanied by purging. The “Fast Track” trial induces participants to behave in a way that mimics Anorexia Nervosa (AN) (severe restriction of calories), placing them in considerable risk of going on to develop AN, Bulimia Nervosa (hyperphagia with or without purging), or Binge Eating Disorder (hyperphagia).”

“There is abundant evidence that bulimic episodes carry with them an immediate risk of death due to electrolyte imbalance and its impact on a variety of bodily systems if left untreated. Other risks associated with bulimic episodes include refeeding syndrome, cardiac failure, kidney failure, haemorrhage, dental erosion, hernia, compromised pulmonary function, impaired reproduction.”

“Although the research proposal suggests that the risk of bulimic episodes is secondary, and not warranting disclosure of risk to participants and their guardians, there has been no consideration given to the increase in the likelihood of such episodes stemming from both the premise of the study itself, and also the deliberate placement of the participants in a calorie deficit that falls within the category of “clinical starvation.”

“Dieting at any level has been termed the “most important predictor of eating disorders.” It has also been identified as “a risk factor for both obesity and eating disorders.”

“Extreme calorie restriction causes bone density loss, with many studies of starvation and the bone metabolism in laboratory animal models and humans finding evidence of either developmental delays, stunted bone growth, decreased bone mineral density or decreased cortical strength.”

“Given that weight loss is generally maximal at 6-12 months, the results of the “Fast Track to Health” trial run the risk of being skewed, because the subjects would not be followed for the length of time necessary to ascertain long term sustainable change.”

“There is compelling evidence that the “Fast Track to Health’ trial is incapable of achieving its express goal of “reducing weight and improving risk factors for heart disease and diabetes”, given that weight loss is not sustainable, with a 97% rate of regain. Calorie restriction can cause prolonged psychological distress, which in itself has been identified as a contributing factor to a number of physiological conditions, including cardiovascular disease, T2D, and metabolic syndrome because of the mechanisms involved in cyclic loss and gain.”

“Added to this established evidence that dieting in adolescence can trigger the onset of an eating disorder, including AN, BN, BED and OSFED. Even if the person does not acquire an eating disorder, they are at a considerably heightened risk of entering into cyclic weight loss and gain, which carries already mentioned health risks, including bone density loss.”

This is the second ethical complaint regarding the study.

The aforementioned Louise Adams appeared on radio station ABC Melbourne to bring public awareness to this ill-advised study.

The advocacy group, Eating Disorders Families Australia released a statement condemning the study and requesting that it be stopped.

HAES Australia endorsed the Complaint, condemned the study and issued its statement.

And then, the Academy for Eating Disorders, the world’s largest eating disorder organization issued its statement. This statement includes the following language: “Ultimately, the AED Board of Directors concluded that there is merit to many of the concerns raised. In particular it is critical to judge the likely benefits of any proposed research against its risk of harm and in this case, we are not convinced that the prospects of benefits sufficiently offsets the risks. We agreed that the AED will compose a position statement about the importance of fully considering the risk of increasing eating disorders and related problems alongside the gravity of this risk for the individuals put in harm’s way. When children or adolescents are the ones affected, the stakes are particularly high.”

To support their brethren and colleagues “Down Under,” organizations in the United States rallied to the cause. The international parent organization F.E.A.S.T., under the leadership of Laura Collins Lyster-Mench, has been speaking out against the study since it came to light in the latter part of 2018. The Eating Disorder Coalition condemned the study. Chevese Underhill Turner, Founder of the Binge Eating Disorder Association (“BEDA”) which recently merged with NEDA, stated: “There is no way to make a very low calorie diet and intermittent fasting trial safe for children. The risk clearly outweighs the benefit.” Doctors, dieticians and counselors to a person have uniformly questioned the efficacy of the study.

Other than the research doctors participating in the study, it appears as if the eating disorder industry has risen as one and not only condemned the study, but are taking proactive steps to attempt to stop the study … before even one child can be hurt by the hubris and egomaniacal needs of the research doctors.

Ms. Turner also stated, “We must also get past not speaking up because we are worried about offending colleagues. This can be done respectfully. Good people make poor decisions in research at times —they are human and have biases and blind spots like we all do. Protecting those biases and blind spots does not help anyone.”

Up to this point, the opposition to this study has been collegial and respectful. The opposition has been organized and scholarly. The legion of information establishing the extreme risks of this study has been provided in a professional manner. As such, the researchers can no longer claim “a blind spot.” The extreme risks have been disclosed by medical professionals, counselors and interested persons who have decades of experience. The researchers must know that this study will never be duplicated anywhere else in the world because of the risks. And if the doctors and medical professionals insist on proceeding with the study regardless of this overwhelming information, then surely, the gloves must come off.

Imagine a parent of one of the children in this study. Imagine not being informed of all of the possible risks. And your child is one of the children who develops an eating disorder. The frantic trips to the emergency room. Repeated blood tests showing irregularities in potassium, magnesium, and blood sugar. Perhaps a heart valve starts to leak. Seizures. And you find yourself in the fight for your child’s life. Fear becomes an every day, every minute visitor in your household. And then you discover that the doctors and professionals in this study had actual knowledge of these risks … and did not disclose all of these risks to you. The disbelief you would feel. The rage.

And so, dear doctors and other professionals conducting this study … proceed with the study … at your professional peril. But know that when you do, you too have risks. If and when the study does not produce any duplicable, tangible results. If and when a number of children in this study develop eating disorders. If and when you read the numerous complaints and studies opposing your studies. If and when you realize that the world eating disorder community has united as one condemning your study … and yet, you elected to proceed.

You will be alone. You very well may have blood on your hands. You will be a worldwide pariah. Your career may very well be over. But, that is ok. You can always find employment as a short order cook in a fast food restaurant serving up double cheeseburgers while you pontificate on how starvation diets actually do work.

But regardless, thank you. Thank you for uniting the eating disorder community and industry. Thank you for providing the platform by which one, strong unified voice was heard.

You may very well have discovered the formula by which collaboration and concerted efforts can come together to provide the basis upon which new breakthroughs are possible. Proving that even the Village Idiot can serve a useful purpose.

Ethics Complaint

“The Devil’s agents may be of flesh and blood may they not?”

     Sir Arthur Conan Doyle, The Hound of the Baskervilles

Many people in the eating disorder community profess to know, hope, believe, or want to believe that the insurance industry as a whole does not work against the best interests of their insured and medical providers and are not primarily concerned with their financial self-interest. And then, we encounter a person, an event or conduct that seems so implausible and so outrageous, that when proven true, has the ability to shake our belief to its very core.

On February 6, 2019, a lawsuit entitled Avalon Hills Health Care, Inc. vs. United Health Group, Inc, et al was removed from a state court in Utah to the United States District Court for the District of Utah. It was assigned cause number 1:19-cv-00009. The plaintiff’s allegations, if and when proven true, have the potential to shake the foundations of the manner in which insurance providers evaluate claims. At the same time, it could also pull back the curtain that hides the abuse of discretion and power held by peer review doctors employed by those insurance providers.

The lawsuit alleges that on behalf of a number of patients, Avalon Hills entered into single case agreements with United Behavioral Healthcare a/k/a Optum (“Optum”) so that Avalon Hills could render eating disorder treatment to its patients. In those single case agreements, Optum agreed to make payment for treatment rendered by Avalon Hills. Then, in April 2018, Optum sent a notice to Avalon Hills advising that payment for treatment for all patients under which a single case agreement was in place was being immediately stopped. [and contrary to the 30 day requirement in the single case agreements.] Despite having a long satisfactory relationship with Avalon Hills, Optum claimed that Avalon Hills was not providing medical oversight in accordance with Optum’s Level of Care Guidelines. [Curiously, Optum’s Guidelines do not include the DSM-V guidelines]

If that were the end of the dispute, the lawsuit would fall into that category of not atypical disputes between a medical treatment provider and insurance provider. It would have an impact upon the parties to the lawsuit but not much significance to the industry as a whole. But, that is not the end of the story. Far from it.

The lawsuit also alleges that Optum’s employees and contractors, including Dr. Randall Solomon who is based in the San Francisco Bay area began to contact the patients at Avalon Hills, and/or the parents or agents of the patients at Avalon Hills and advised them that payment was being immediately stopped and that no long term payments would be made. Optum’s employees allegedly also advised the patients that they should transfer to other facilities, most all of which had in-network contracts with Optum. These employees also told the patients or their families that Avalon Hills was not licensed to provide care and services. According to the lawsuit, the employees also stated that staff members at Avalon Hills abused patients!

The lawsuit alleges that Dr. Solomon, who was employed as an Associate Medical Director by Optum Health from January 2014 through February 2016 in the San Francisco Bay Area, [and subsequent thereto, has been used by Optum in peer-to-peer reviews] “… told insureds or their family members or agents that the Plaintiff [Avalon Hills] has used physical restraints on patients and forcibly injected them with sedatives. Specifically, Dr. Solomon told patient A.H.’s parents that A.H. had been restrained and injected against her will.” [emphasis added]

Dr. Solomon was not yet finished. According to the lawsuit, he also filed a complaint against Avalon Hills with the Utah Department of Health alleging that Avalon Hills had physically restrained and injected patients. As a result, the Utah Department of Health conducted an investigation into Avalon Hills. Its finding? It determined that Dr. Solomon’s claims were without merit.

These statements on the surface appear to be so grossly outrageous that they beggar belief. And yet, Dr. Solomon’s complaint to the Department of Health and its subsequent rejection exist. The lawsuit is pending in federal court and is a matter of public record.

And so surely, we must examine the motivations of each party. With regard to Avalon Hills, if their allegations are not true, then making such allegations in a public forum can only be looked upon as a “Hail Mary.” It would be a desperate attempt to extort Optum into making a large financial settlement in order to stay in business. This would undoubtedly be brought to light and would constitute the death knell for Avalon Hills. But, with eating disorder admissions in hospitals and treatment centers on the rise, and with Avalon Hills having a consistent patient census, that scenario seems very unlikely. Further, if the allegations of the complaint are true, then the motivation for Avalon Hills is clearly to step to the plate, to stand behind its practices and principles, to not back down and to show not just Optum, but the entire eating disorder industry that it believes in its program and will defend it.

Before exploring the motivations of Optum and Dr. Solomon, we must first question the peer review process used by Optum. First, Optum as the insurance provider has the absolute duty of good faith and fair dealing with the patient, its insured. To this end, an insurance company must investigate a claim expeditiously and reasonably and must not unduly delay in making a payment decision and rendering payment. It may also not deny a claim when there is no reasonable basis.

The peer review process is supposed to be objective. The insurance company should utilize independent outside third party doctors with experience in the medical treatments at issue. The peer review doctor is supposed to carefully review the medical records of the patient. With objectivity as the goal and with the requirement of good faith to the insured, why then is Optum employing a former employee, an associate medical director as a peer review doctor almost immediately after he left their employment? A doctor who was employed by OptumHealth in 2016. And as soon as  2017, he was the “outside” medical reviewer employed by Optum on Avalon Hills patients. Isn’t that is the very definition of the appearance of impropriety? At the same time, Dr. Solomon lists himself as a forensic psychiatrist and that his “… legal and forensic work covers a broad range of issues …” [In the practice of law, we call those persons, witnesses for hire.] In any event, it would appear as if Dr. Solomon merely went from being a paid employee of Optum to a paid “consultant” employed by Optum.

Dr. Solomon presumably has a contract with Optum. This contract involves reviewing claims being processed by Optum. Pursuant to this contract, Dr. Solomon is being paid to provide this service. Like all insurance companies, Optum is in the business of making a profit. One would be justified in wondering if Dr. Solomon, as a hired gun, did not consistently side with Optum and instead, sided with the treating medical professional and recommended payment for additional treatment, whether his contract with Optum would be renewed. The reality is that the more times Dr. Solomon sides with Optum and against the treating medical professional, the more money Optum saves and meanwhile, Optum maintains a façade of plausible deniability.

According to the lawsuit, six (6) patients were identified by their initials. In general, the cost of residential treatment is approximately $30,000 per month. The lawsuit alleges that each of these patients was contacted by employees of Optum and/or Dr. Solomon and the statements above were made to them. One can readily infer that the statements were obviously made with the intent of inducing them to leave Avalon Hills. If the patients had left, Avalon Hills would have incurred a potential loss of approximately $180,000 per month. And Optum would have financially benefitted since if the patients had gone to Optum’s in-network treatment providers, the financial exposure for Optum would be less perhaps substantially so.

Large financial exposure. Possible libel and slander. A medical career of not only a treatment center, but a psychiatrist at stake. And patients, our loved ones suffering from this disease, being treated as pawns by Optum.

If all allegations are proven to be true at trial, the ramifications of this alleged gross, outrageous conduct will echo through the eating disorder industry and insurance peer doctor review business. And the very words which constitute the bedrock of a physician’s practice … Primum non nocere … “first do no harm” will be sorely tested.

The National Health and Medical Research Council in Sydney Australia is underwriting and conducting a study known as “The Fast Track to Health.” This twelve (12) month study will be performed on guinea pigs … uh, children from the ages of 13 years to 17 years of age.

The Fast Track website states, “This is a research study for young people well above a healthy weight.”

This Study requires the children to follow extreme calorie restriction diets (800 calories per day) for one month. This will then be followed by 12 months of low calorie dieting for half the participants, and alternate day fasting for the other half. Children in the fasting group would eat just 600–700 calories a day for three days a week, approximately 25–35 per cent of estimated daily energy needs. The remaining four days would be a standard diet.

According to the website of the $1.2 million dollar study, the study’s aim is to “determine if MADF [Modified Alternate Day Fasting] is effective, safe and acceptable to adolescents compared to a standard weight control diet”.

In a co-signed letter to the Human Research Ethics Committee (HREC) at Sydney Children’s Hospitals, 29 health experts from Australia and the United States expressed concern that MADF is not safe nor effective for children. These experts are demanding that the study be abandoned claiming it poses unacceptable risks to children’s health.

In responding to the complaints, Ms. Asra Gholami, executive officer of research ethics at Sydney Children’s Hospitals Network, wrote: “The HREC recognises that there is a risk for a young person to develop an eating disorder with exposure to restrictive diets, and in particular very restrictive diets. Although these risks appear to be lower in medically supervised dieting programs, they will still be present.”

Ms. Gholami then digs her grave even deeper by stating that the risk of children developing an eating disorder is justified because of the potential for the participants to lose weight.

The Fast Track study researchers also acknowledge previous fasting diet studies did not produce long-term weight loss results.

The final nail in this ill-advised coffin is despite the fact that HREC is acknowledging the risks and limitations of the study in correspondence with health professionals, this information is not being given to the parents when signing their child up for the study.

To summarize, it would appear as if the researchers acknowledge the risk that some of their guinea pigs will develop an eating disorder as a result of this trial; that previous studies did not produce long-term weight loss results, and; they are not going to make complete disclosure of the risks and limitations to the parents of the guinea pigs.

It would appear as if the HREC’s position is that they are going to take children who mainstream society would consider obese, children who already may be very emotionally vulnerable and at high risk, and subject them to conditions which could, and in all reasonable medical probability, will result in some of them developing an eating disorder, a disease that we know has the highest mortality rate amongst all mental illnesses.

One can also speculate that if even one of these children dies as a direct result of developing and then succumbing to an eating disorder is that too high of a price to pay for some subjective results from this study? Are two children too many? What is the price in blood that would need to be paid for a study that in all reasonable likelihood, cannot be duplicated outside of the alleged “strict parameters” the HREC is implementing?

Past recent articles have focused on the Health at Any Size Movement. Chevese Turner is the Founder, President and CEO of the Binge Eating Disorder Association (“BEDA”) which has merged with the National Eating Disorder Association. I respect Mr. Turner very much for amongst other reasons she is a champion of the Health at Any Size Movement. She has commented and educated with passion and resolve. Amongst other statements, she said, “Many people don’t talk about it or speak up when HAES is challenged because the research community can be pretty condescending about their views and shut clinicians down. For this reason, a smaller group of HAES aligned clinicians and advocates have been speaking out and “disrupting”. We’re tired of being misinterpreted and condescended. We’re also tired of the harm being done to fat folx with EDs. At some point people have to stand up, but this is not received well within current power structures.”

And if ever there was a time for the HREC researchers to stand up and listen to champions like Ms. Turner, the time is at hand. Yes, 29 professionals have objected to this misguided study. But, that is not enough. More pressure needs to be brought to bear.

We know that the Academy for Eating Disorders (“AED”) is holding its International Conference in Sydney, Australia in June 2020. Eating disorders scientists, research doctors and clinicians will be flying into Sydney from all parts of the globe. The economic boon to Sydney and Australia will undoubtedly be well over $1,200,000, the cost of the study. If AED was not even approached about the HREC study and is not yet one of the 29 experts who have complained about this study, imagine the impact were AED to rise up as one and submit its concerns to HREC.

In 2014, The Royal Australian and New Zealand College of Psychiatrists issued some comprehensive clinical practice guidelines for treating eating disorders. I failed to locate that portion of that study indicating that starving your patients though a grossly restrictive diet was an effective and recommended clinical practice. Certainly, if the RANZCP has not yet responded with the strongest rebuke possible since this ill-advised study goes against the very substance of the 2014 clinical study, it needs to take that action.

In 2019, it is incredible to believe that any competent medical practitioner would endorse starvation through diet as an effective means to battle what society regards as “obesity.” The HREC’s anachronistic view on eating disorders and starvation diets is tantamount to using leeches, bloodletting and implanting goat testicles as mainstream medical treatment.

Otherwise, what can be done? Joan Riederer, the founder of the “Sock It To Ed Foundation,” in honor of her beloved daughter Erin Riederer, posted a petition on its Facebook page to let your voices be heard. That link is set forth below.

A starvation diet for our children to battle obesity. Acknowledging that the diet could result in the development of eating disorders. And, not making full disclosure to parents. Should even one beloved child die as a result, the ramifications could be much worse than just civil litigation. If you choose to gamble with a child’s life by exposing them to a known risk which could result in their death, the criminal justice system awaits you … and deservedly so.

Joan’s petition …

https://www.change.org/p/dr-michael-bryden-say-no-to-starving-our-teens-stop-the-fast-track-trial-1d356ed5-e8d5-48dc-b168-7710fcf062a4?recruiter=10064404&utm_source=share_petition&utm_medium=facebook&utm_campaign=psf_combo_share_initial.pacific_post_sap_share_gmail_abi.gmail_abi&utm_term=psf_combo_share_initial.pacific_post_sap_share_gmail_abi.gmail_abi&recruited_by_id=d70339f0-2f8d-0130-a65a-3c764e049c64&utm_content=fht-14288926-en-au%3Av6&fbclid=IwAR2ZNicfQ3UfUJ8FX14JFYwewgLALDgTkMKCS302XwIuuAzH89RMJ4O-5wU

On our journey through life, we encounter numerous crossroads. Choices and decisions are laid before us. Or sometimes they are made for us. At times, we may even find ourselves feeling as if we are being inexorably guided by some intangible, incorporeal feeling or sensory perception. Sometimes we look back upon the outcome or consequences of such decisions and are left wondering how we got to a certain place. This is particularly true in matters involving our health and the health of our loved ones.

I do not often write of my own personal experiences because quite frankly, my life is fairly mundane and of no particular interest. And yet, at times I sense that I am a conduit for far more important, more grand issues and messages. The Power of the Message. Not the Image of the Messenger. And yet, a recent event has made me again question whether we end up at various places in our life due to … Fate? Coincidence? Luck? Or…is there something greater at play?

On Super Bowl Sunday, I got a call from my 88-year-old father. My dad is a former air force pilot, was raised in the Midwest with that generation of men who didn’t show much emotion. He was the single breadwinner in the family. So, when he called saying he was in extreme pain in his abdominal region, I took notice. We ended up in the Emergency Room at Presbyterian Hospital in Dallas. This is the hospital in which my daughter, Morgan breathed her last in October 2016. And every time I have had to go to that hospital after that dark night, this sense of cold foreboding has gripped me.

The following day I received the news that my dad had gallstones which blocked the flow of bile. This was causing the severe pain. On Tuesday, the medical professionals inserted a tube down his throat to remove the gallstones. That procedure went well. However, discrepancies were found which resulted in the decision to remove his gall bladder the following day.

So too, the gall bladder removal surgery was successful. The attending doctors stated that surgery went off smoothly and he was being released the next day, that being Thursday. I picked him up from the hospital about 1:00 o’clock p.m. He was in good spirits and relatively pain free. I thought, “Not bad for an 88 year old man!” Two hours later those thoughts were ripped from my heart.

The attending doctor called me and asked me to bring my father in to see him the very next day. He advised that the pathologist had found a cancerous tumor in the gall bladder. He also said that the pathologist happened to be a friend of his and for no particular reason, had focused on the report of my dad. Instead of 2 to 3 days, the call came within 1 day.

We met with the doctor on Friday. He explained that because the cancer had been found at such an early stage, it had not yet spread throughout the liver and removal surgery was a viable option. But, he also advised that about 5 days after surgery, scar tissue begins to form and surgery would be more problematic. He also advised that although fewer than 20,000 people in the United States get gall bladder cancer every year, it is one of the most aggressive cancers and if not treated immediately, in all likelihood, he had fewer than 6 months of life remaining.

On Monday, February 11, 2019, the doctors operated and removed the cancerous part of the liver wall. Their post surgery report was glowing. They believed they got all of it but we are waiting on the pathology report … again.

As I sat with my father in ICU, I was very aware that his room was just two floors below the ICU room where my beloved daughter breathed her last just two years before. The rooms looked largely identical. The beeping of the medical equipment. The attention from the medical staff. The pain and anguish from that dark October night began once again, to wash over me. And then, through the grief, perhaps clarity began to happen.

But for the gallstones lodging in his bile duct in a certain exact way, he would not have had the severe pain. Without the severe pain, we would not have known of his gall bladder issue for several more months. Those several additional months would have resulted in the rapid spread of the cancer and my dad’s almost certain death in 2019. Had the gall bladder not been removed, and the pathologist not been a friend of the surgeon and for some unknown reason, been drawn to immediately review my dad’s test results, additional time would have elapsed and scar tissue would have begun to form and again, the cancer would have had additional time to spread.

As I sat in that ICU room, all of those “coincidences” became so clear. And a sense of peace came to me. An unexpected peace which shone through the fear and exhaustion and in the most unlikely of places.

Were all of those circumstances merely a chain of coincidences inextricably linked together? Was it fate? Could it have been blind dumb luck? Or, in our lifetimes, lifetimes that are far too short for many, is there really any way to begin to grasp the vast expanse and power of some incredible energy, life force or Divinity far greater than our meager existence?

Faith for the most part is not included as an important consideration in programs offered by most eating disorder centers, hospitals and professionals. There are no “evidence-based” studies indicating the effectiveness of faith in eating disorder programs. You cannot see faith. You cannot test faith. In fact, faith by its very essence is not based upon demonstrable facts. It stands upon its own. And sometimes, when all else fails, faith comes to us in our hour of need and it strengthens us.

For our loved ones suffering from eating disorders, sometimes, when our prescription drugs have failed, when tube feeding has failed, when our loved ones are in the darkest pit of despair…. sometimes faith comes to them.

And for those who have had one beloved life unfairly and prematurely ripped away, and one beloved life saved through the most improbable of circumstances … sometimes, faith becomes a lifeline.

P.S. On Wednesday, February 13, the pathology report came back. The doctors were able to remove all of the cancer cells. There is no lingering or residual cancer, no chemo is necessary and he is expected home by Sunday. Luck? Skilled surgeons? Guardian Angel? Whichever may be the case, gratitude

Recently, we addressed the Health at Every Size (“HAES”) movement which has, over time developed in the eating disorder community. We postulated that the HAES movement was at best lightly regarded if not outright disregarded and/or unknown by mainstream society and was in fact, in some ways, a detriment hurting the eating disorder community.

We noted that the HAES movement at its core is about fairness and equality. It is about casting off the shackles of prejudice of a society that wrongly places value on the model thin body. It is about non-acceptance of a person. It is about stereotyping a person because of how they look. It is about speaking out against the degradation of a person because they are different. It is about casting aside mainstream views of a person based upon incorrect and faulty information.

We concluded that the HAES movement does not belong in the eating disorder industry and community. That in many ways, HAES and eating disorders are only loosely connected. We theorized that the HAES movement is not an eating disorders issue but instead is a civil rights movement.

And in support of those musings, we can now present you some evidentiary exhibits. From Wednesday, February 6, 2019 through Sunday, February 10, 2019, the international association of eating disorders professionals (“iaedp”) will be meeting on the frozen tundra of Palm Springs, California. This five (5) day international conference will bring together some of the most well known clinicians and treating doctors in the eating disorder industry.

The topics to be discussed will be many and varied. They include “dysfunctional passion” and psychodrama. Dissociative identity disorder and “healing emphasis yoga.” Exercise in the treatment of eating disorders and body image disturbance. Implementing LBGTQ+ Inclusive and Gender Affirming Programming and Nutrition therapy. Sessions in Spanish language. Intuitive eating and military service. Recovery from shame, weight restoration and shame. A clinician’s guide to coping with the suicide of a patient. Atypical anorexia, Family Based Therapy and Cognitive Behavioral Therapy. Evidence-based Therapy. Body Dysmorphic Disorder and integrating telehealth interventions. Utilizing laughter in therapy and treating athletes with eating disorders. Inspiration and joy in the recovery process and even … veganism. This wide cornucopia of topics seemingly covers every possible topic in the eating disorder community and industry. Seemingly all topics save one.

In the five (5) days of meetings, there is not one mention of the Health at Every Size movement. There is not one mention of treating what mainstream society would regard as the obese patient. There is not one mention of topics such as weight stigma, fat shaming, the manner in which BMI has come under attack, the prevalence of binge eating disorder or legislative advances on behalf of the HAES movement. Starting at 8:30 o’clock a.m. on Wednesday and concluding at 12:30 o’clock p.m. on Sunday, not one minute was specifically spared for HAES.

To be fair, perhaps this was an anomaly. So, research was undertaken into the 2018 iaedp Symposium. In the five (5) days of the 2018 Conference, we discovered no time set aside for HAES although there was one (1) session on “Weight Stigma in Eating Disorder Treatment Settings: A Discussion on Identification & Reduction.”

At the 2017 iaedp Symposium, again there was no mention of HAES. (Although discredited and disreputable psychologist Mark Schwartz did present a session on “Eating Disorders, Sexuality and Intimacy.” One can’t help but wonder if he utilized his penchant for brainwashing,  hypnosis and concocted memories as set forth in four lawsuits against him during that session. And yet, I digress.)

Perhaps the omission of HAES should come as no surprise. In 2015, the National Institute of Health published a comprehensive study entitled, “Impact of weight bias and stigma on quality of care and outcomes for patients with obesity.” As stated in the study, “The objective of this study was to critically review the empirical evidence from all relevant disciplines regarding obesity stigma in order to (i) determine the implications of obesity stigma for healthcare providers and their patients with obesity and (ii) identify strategies to improve care for patients with obesity.” Amongst the findings and conclusions, the study included the following statements:

– Many healthcare providers hold strong negative attitudes and stereotypes about people with obesity. There is considerable evidence that such attitudes influence person-perceptions, judgment, interpersonal behaviour and decision-making.

– Stigma can reduce the quality of care for patients with obesity despite the best intentions of healthcare providers to provide high-quality care

– Obesity is a commonly and strongly stigmatized characteristic. There is substantial empirical evidence that people with obesity elicit negative feelings such as disgust, anger, blame and dislike in others

– Furthermore, there is a growing body of evidence that physicians and other healthcare professionals hold strong negative opinions about people with obesity

– Primary care providers, medical trainees, nurses and other healthcare professionals hold explicit as well as implicit negative opinions about people with obesity.

– The combination of implicit and explicit negative obesity attitudes may elevate the potential for impaired patient-centred communication, which is associated with a 19% higher risk of patient non-adherence, as well as mistrust, and worse patient weight loss, recovery and mental health outcomes.

– Finally, physicians may over-attribute symptoms and problems to obesity, and fail to refer the patient for diagnostic testing or to consider treatment options beyond advising the patient to lose weight. In one study involving medical students, virtual patients with shortness of breath were more likely to receive lifestyle change recommendations if they were obese (54% vs. 13%), and more likely to receive medication to manage symptoms if they were normal weight (23% vs. 5%).

A link to the study is included below[1].

With such a damning study, as well as other similar studies readily available online, one should assume that if the eating disorder industry was serious about being “all inclusive,” it would be embracing the HAES movement and including this vitally important information as educational enrichment for its members every year. This would be especially true since binge eating disorder is the most common eating disorder. And yet, iaedp at its conference is as silent as the tomb on these issues this year.

Perhaps the eating disorder industry is supportive in other venues. This year, the 7^th Annual International Weight Stigma Conference is being held in Toronto, Canada in June (thank you to Chevese Turner for that information). And investigation into the sponsors of this event the previous year reveals the following sponsors: Frontiers [an open science platform]; Leeds Beckett University; Friend of Marilyn [social media advocate]; Wiley Publishing; Pearlsong Press; ASDAH; NAAFA [non-profit human rights organization]; Routledge Journals; SPSSI [international group of scientists and psychologists].

There is no Residential Eating Disorder Consortium (“REDC”). There is no ED Coalition. There is no National Eating Disorder Association. (“NEDA”) There are no United States treatment centers. There are no private equity firms. There are no eating disorder related foundations or United States organizations. No sponsorships at all. No investment of time. No investment of money.

The ED Coalition is charged with representing the eating disorder community on Capitol Hill. Thorough research enables you to discover the identity of the lobbyist utilized by the ED Coalition, the REDC and NEDA. Paid lobbyists are required to file quarterly reports which sets forth the amounts they are paid, the bills upon which they are lobbying and the specific portions, if any, of those bills. A review of the bills being pursued by the lobbyist utilized by these organizations indicate lobbying on bills impacting additional education for primary care givers and doctors, allowing Tricare coverage of eating disorders to stand alone treatment centers and requiring insurance companies to specifically include residential treatment centers under parity laws in insurance policies. (Although arguably, the Mental Health Parity Act and Affordable Care Act should have taken care of that issue.) There is no mention at all of HAES or the Health at Every Size movement.

In the prior article, I opined that the HAES movement is much more of a social justice movement, an ipso facto civil rights movement. It involves perceptions, discrimination and disparate treatment of HAES. That it is only loosely connected to the eating disorder industry. And understandably, there was respectful disagreement and intelligent discourse on that topic. But now, there is concrete evidence of the manner in which the eating disorder industry treats the HAES movement through its conduct and omissions backed by a research study.

When the biological genesis of certain types of “obesity” is revealed and disclosed, then there will be lawsuits filed on behalf of those who are discriminated against, stigmatized, ignored and mocked. For sometimes this reprehensible conduct manifests itself openly and notoriously. However, most times, the misconduct is far more subtle … existing in the shadows along with the disease itself.

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4381543/

Let’s address the Health at Every Size (“HAES”) movement which has, over time developed in the eating disorder community. At the same time, let us also give a forum to the many whispers and voices behind the scenes about which I and many others have heard. And maybe at the end, let’s propose a radical, bold direction for HAES.

After listening to a number of people with experience in the eating disorder industry, the message which keeps being delivered is … The HAES movement is at best lightly regarded if not outright disregarded and/or unknown by mainstream society and is in fact, in some ways, a detriment that is hurting the eating disorder community.

Now in reading up to this point, some people may have spewed coffee over their computer screen, cursed me and every living and dead relative I have, employed the nearest hit man or have already dismissed the message in this missive. But, nonetheless, let’s continue.

If there is any merit behind these messages, the issues presented could be addressed simply by rebranding or something even more radical. This could bring greater credibility and accessibility to its cause. But even that might not be enough.

On the HAES community website, haescommunity.com, the following language appears,

“RESPECT … Honors differences in size, age, race, ethnicity, gender, dis/ability, sexual orientation, religion, class, and other human attributes.”

“CRITICAL AWARENESS … Challenges scientific and cultural assumptions.”

This website then states, “It supports people of all sizes in addressing health directly by adopting healthy behaviors. It is an inclusive movement, recognizing that our social characteristics, such as our size, race, national origin, sexuality, gender, disability status, and other attributes, are assets, and acknowledges and challenges the structural and systemic forces that impinge on living well.”

On the website for the Association for Size Diversity and Health (“ASDAH”), with regard the HAES Principles and Approach it states:

The Association for Size Diversity and Health (ASDAH) affirms a holistic definition of health, which cannot be characterized as simply the absence of physical or mental illness, limitation, or disease. Rather, health exists on a continuum that varies with time and circumstance for each individual. Health should be conceived as a resource or capacity available to all regardless of health condition or ability level, and not as an outcome or objective of living. Pursuing health is neither a moral imperative nor an individual obligation, and health status should never be used to judge, oppress, or determine the value of an individual.

In reading these principles, vision and mission, one can understandably question whether they are reading a mission statement of a political party, a website advertisement for a new yoga/meditation regiment, a follow up outreach contact from a doctor or clinician … or a statement of principles from a social justice movement.

We do know people are not biologically healthy at “every size.” To hold counter to this scientific fact is tantamount to shaking one’s fist at the clouds. Any competent doctor is going to tell you that excess body weight is a risk factor for most major, chronic diseases. The connection between excess weight and conditions like type 2 diabetes, sleep apnea, and arthritis has been scientifically demonstrated. Additional conditions are linked to obesity … heart disease and stroke, cancers of the colon, endometrial, kidney and esophagus. The risk of gall bladder disease or gallstones is increased. Osteoarthritis and gout are more common and linked to obesity. If the HAES movement regards these truisms as mere scientific “assumptions,” they are consciously choosing to ignore countless, objective scientific research studies conducted over a span of decades. And yet, it appears as if the HAES movement wishes to disregard these studies because they do not like the outcomes or their perceptions. If HAES continues to equate scientific research supporting the belief that excess weight is bad because it results in a much greater potential for serious physical health issues with it simply being a moral judgment about people’s bodies, then HAES is doing itself and its followers a tremendous disservice.

If a person does not believe the sun rises in the east and sets in the west, and trumpets this belief, this lack of credibility touches all other issues. And it does not have to be that way.

There are many issues raised by HAES which are legitimate and compelling. Many of HAES’s talking points are supported by the medical industry, clinicians, doctors and scientists. Attacking BMI and the definitions of “obesity” are near the top of these issues. There is no dispute that BMI is coming under greater attack from doctors, clinicians, and scientists. Recent studies indicate it is relatively poor at assessing chronic disease in either direction.

But, where HAES fails is with the realization that proponents of HAES tend to blur the distinction between weight not being the most important measure of health … to weight not being relevant at all to health. And that is a distinction with a difference. And perhaps that distinction is not only being lost but not propounded at all because of the reality that obese people are stigmatized and ostracized by mainstream society.

Review again statements made by HAES. “It is an inclusive movement, recognizing that our social characteristics, such as our size, race, national origin, sexuality, gender, disability status, and other attributes, are assets, and acknowledges and challenges the structural and systemic forces that impinge on living well.” The HAES movement also states, “Honors differences in size, age, race, ethnicity, gender, dis/ability, sexual orientation, religion, class, and other human attributes.”

If we review the first three core principles of HAES, we find the following:

1. Weight Inclusivity: Accept and respect the inherent diversity of body shapes and sizes and reject the idealizing or pathologizing of specific weights.
2. Health Enhancement:Support health policies that improve and equalize access to information and services, and personal practices that improve human well-being, including attention to individual physical, economic, social, spiritual, emotional, and other needs.
3. Respectful Care: Acknowledge our biases, and work to end weight discrimination, weight stigma, and weight bias. Provide information and services from an understanding that socio-economic status, race, gender, sexual orientation, age, and other identities impact weight stigma, and support environments that address these inequities.

Look at the impactful words being utilized “…Accept and respect the inherent diversity of body shapes and sizes … equalize access to information and services … work to end weight discrimination.”

Now, let’s review goals and mission statements from other organizations. The American Civil Liberties Union (“ACLU”) states, “ … the ACLU has been our nation’s guardian of liberty, working in courts, legislatures, and communities to defend and preserve the individual rights and liberties that the Constitution and the laws of the United States guarantee everyone in this country.

Whether it’s achieving full equality for LGBT people, establishing new privacy protections for our digital age of widespread government surveillance, ending mass incarceration, or preserving the right to vote or the right to have an abortion, the ACLU takes up the toughest civil liberties cases and issues to defend all people …”

Let’s review the principle objectives of the National Association for the Advancement of Colored People (“NAACP”):

… the principal objectives of the Association shall be:

• To ensure the political, educational, social, and economic equality of all citizens
• To achieve equality of rights and eliminate race prejudice among the citizens of the United States
• To remove all barriers of racial discrimination through democratic processes
• To seek enactment and enforcement of federal, state, and local laws securing civil rights
• To inform the public of the adverse effects of racial discrimination and to seek its elimination
• To educate persons as to their constitutional rights and to take all lawful action to secure the exercise thereof, and to take any other lawful action in furtherance of these objectives, consistent with the NAACP’s Articles of Incorporation and this Constitution.

The impactful, powerful civil rights organizations like the ACLU, the NAACP, LULAC all have similar principles in common … equality of life, liberty and the pursuit of happiness free from discrimination and society’s prejudices and presuppositions. And who does that sound like? The HAES movement speaks of an all inclusive movement and acknowledging that “… social characteristics, such as our size, race, national origin, sexuality, gender, disability status, and other attributes, are assets, and acknowledges and challenges the structural and systemic forces that impinge on living well.”

The HAES movement at its core is about fairness and equality. It is about casting off the shackles of prejudice of a society that wrongly places value on the model thin body. It is about non-acceptance of a person. It is about stereotyping a person because of how they look. It is about degrading a person because they are different. It is about casting aside mainstream views of a person based upon incorrect and faulty information. How dare you judge me because of the color of my skin!!! uh wait … How dare you judge me because of my religious beliefs! uh wait … How dare you judge me because of my sexual orientation! … How dare you judge me because I am obese in society’s eyes.

The HAES movement does not belong in the eating disorder industry and community. The two HAES and eating disorders are in many ways, only loosely connected. And quite frankly, the eating disorder industry might not be a powerful enough platform (YET), to spread the message, mission and principles of the HAES movement.

The HAES movement is not at its heart, an eating disorders movement. The HAES movement is a civil rights movement. And perhaps the scientific assumptions from which the HAES movement tries to distance are the very fundamental core beliefs which could provide the foundation upon which the HAES movement could project itself into “a protected class” under the Constitution and laws of the United States.

At the start of this article, I made the statement that perhaps The HAES movement was a detriment hurting the eating disorder community. The equally impactful question should also be, is the eating disorder community and industry hurting the HAES movement?

If the HAES movement is truly a civil rights movement, if it is designed to address the wrongs and misdeeds being perpetrated by mainstream society, then it needs a dynamic, powerful independent voice to give meaning and substance to its message. And make no mistake, HAES has a powerful, substantive message to send. It just needs to find an effective platform and forum for that message.

(Thank you to the incredible Chevese Turner for the correction on the name of the movement… and her insights! Chevese, you are a warrior.)