Even after more than a year of maintaining a normalized body weight, young women who recovered from anorexia nervosa show vastly different patterns of brain activity compared to similar women without the eating disorder, Walter H. Kaye, M.D., professor of psychiatry, University of Pittsburgh School of Medicine, and colleagues report in the December issue of the American Journal of Psychiatry.

Studying these differences in brain function could lead to a better understanding of why some young women, who are typically worriers and perfectionists in childhood, are at greater risk of developing the disorder. Evidence also shows that such patterns of temperament persist even after recovery.

“Functional magnetic resonance imaging (fMRI) of the brain is providing new clues to why people with anorexia nervosa are able to deny themselves food and other immediately rewarding pleasures,” said Dr. Kaye, who is director of the eating disorders research program at Western Psychiatric Institute and Clinic of the University of Pittsburgh Medical Center (UPMC) and has a joint appointment as professor of psychiatry at the University of California, San Diego. “In addition, we have a new understanding of why people with anorexia seem to worry so much.”

Dr. Kaye and his colleagues studied 13 women who had recovered from anorexia, maintaining a normal weight and regular menstrual cycles for at least one year, and 13 healthy women in a control group. Each was asked to guess whether a flashing question mark on a computer screen represented a number higher or lower than five. Correct guessers were rewarded with $2, while incorrect guessers forfeited $1. Brain activity in the anterior ventral striatum and caudate regions were monitored during game play with fMRI brain imaging. The anterior ventral striatum is associated with instant emotional responses, while the caudate is involved in linking actions to outcome and planning.

“During the game, brain regions lit up in different ways for women who formerly had anorexia compared to healthy controls. While the brain region for emotional responses showed strong differences for winning and losing in healthy women, women with a past history of anorexia showed little difference between winning and losing,” said Angela Wagner, M.D., University of Pittsburgh School of Medicine and the study’s first author. “For anorexics, then, perhaps is it difficult to appreciate immediate pleasure if it does not feel much different from a negative experience.”

The caudate regions of the brains of formerly anorexic women, however, were more active than those of healthy controls, especially in the most anxious people, suggesting that women with a history of anorexia were more focused on the consequences of their choices, Dr. Kaye noted, adding that anorexics “tend to worry about the future” and doing things right.

“There are some positive aspects to this kind of temperament,” he said. “Paying attention to detail and making sure things are done as correctly as possible are constructive traits in careers such as medicine or engineering.” Carried to extremes, however, such obsessive thinking can also be harmful, Dr. Kaye added.

Results of the guessing game are instructive because they show that healthy women responded to wins and losses by “living in the moment” and moving on to the next task, while people with a past history of anorexia had trouble letting go. “They tended to try and find strategies within the game, and were concerned about making mistakes,” said Dr. Kaye.

There is no proven treatment that reverses symptoms in anorexia nervosa, which has the highest mortality rate of any psychiatric disorder. Increasing researchers’ understanding of these basic brain differences could influence future development of drugs and other treatments for anorexia, Dr. Kaye added. “We’re starting to understand these processes because we have better tools, such as brain imaging, and a better understanding of how the brain works due to advances in cognitive neuroscience.”

Providing accurate information and improving knowledge of the illness is the most effective preliminary strategy against eating disorders, according to a study in Early Intervention in Psychiatry published by Wiley Blackwell.

Researchers conducted an Eating Disorder Mental Health Literacy (EDMHL) intervention by providing women with eating disorders with treatment information, reputable self-help books and information on where to get further information. The findings were published in the research paper, “Effects of Providing Information on Eating Disorders”.

The EDMHL intervention proved to be successful as participants showed less pessimism about the difficulty of treatment, improved knowledge, increased help-seeking and a significantly improved quality of life.

Lead author Professor Phillipa Hay, Foundation Chair of the Mental Health School of Medicine at the University of Western Sydney said, “The infrequent uptake of treatment by people suffering from eating disorders is associated with poor Mental Health Literacy (MHL), defined as the knowledge and belief about mental disorders. This community-based intervention is aimed at remedying existing misconceptions about eating disorders and its treatments.”

Eating disorders are extremely common, with about one in 20 Australians having issues with disordered eating or extreme body image concerns at any one time.

“Despite the fact that having an eating disorder causes immense distress and prevents sufferers from leading full lives, most people, up to 90%, with the disorders are not receiving help or treatment.” said Professor Hay.

She added, “Our simple and inexpensive intervention prompted over a third of the participants to seek treatment this showing that when people are armed with the knowledge and the right information, they will be more willing to seek out treatment”

If Israeli fashion photographer Adi Barkan has anything to say about it, Israel will soon be as famous in the international modeling world for its revolutionary commitment to health as it is for its up and coming models, Bar Refaeli and Esti Ginzburg.

Barkan, the renowned owner of a Tel Aviv modeling agency, has spent the last few years bringing the problem of eating disorders in the modeling community to light. While international demand for Israeli models has increased, so too has his awareness of anorexia among young girls in Israel and around the world. Just a few months ago he rushed 33-year-old Israeli model Hila Elmalich, who was suffering from anorexia, to hospital after he found her collapsed unconscious on the floor of her home. Elmalich, who worked with the Israeli branch of modeling agency Elite International, died last week, weighing under 60 pounds.

Barkan’s goal, through legislation and public relations, is to try to change the very definition of beauty, one pound at a time. In 2004, working with Knesset member Inbal Gavriely, he successfully submitted legislation to Israel’s Parliament requiring all Israeli modeling agencies to use the Body Mass Index (BMI) as a pre-requisite for employment (BMI is defined as an individual’s weight divided by the square of their height).

At a recent audition in Tel Aviv organized by the Israeli branch of the Elite International agency, which in the wake of Elmalich’s death committed itself to employing models with a healthier BMI, Barkan spread his message to members of the modeling community and media. “When the day comes that a talent agent tells a girl, ‘you’re too skinny’, we’ll have made a change,” Barkan said. “But no one ever says this. It starts with ‘you just need to lose five pounds’ and then it doesn’t stop.”

It may be about to stop. Barkan’s campaign is gaining steam, with over 30 Israeli CEOs having agreed to hire models for their advertisements only after they pass a health exam. In order to maintain their certification to work, models will have to be screened every three months, reaching a minimum level of health. With countries such as France and Italy throwing their support behind this campaign, Barkan hopes his crusade will change how young girls look at themselves.

Dr. Richard Even, an Israeli nutritionist, conducted exams at the audition and advised models how to maintain a certain level of health. According to Even, “there’s a new sheriff in town and his name is Adi Barkan.” Speaking about the teens present, Even emphatically added “if you don’t take care of yourself, you won’t be accepted.”

The campaign for a healthier community is far from a one-man effort. Many have backed Barkan including an organization called the Israeli Center of Changing Eating Habits. While Even and others focus on treatment and testing, this center is tackling perception and mental health through outreach. One such effort took place on the Tel Aviv beach last summer: a fashion show highlighted healthy models who passed the minimum standards of Barkan’s tests, and passersby learned about healthy eating from experts. By changing how young people view beauty, the hope is to reduce eating disorders not only among aspiring models, but also among young girls in Israel and around the world.

In addition to sending out a message of health, the recent audition also served as a reminder that Israel is a hotbed of more than just politics. One of the biggest modeling agencies in the world, Elite International sent international director of scouting Michaela Goddard to Tel Aviv to recruit the next generation of Refaelis and Ginzburgs. Aspiring stars, some as young as 15, sat with Goddard and representatives of the international and local branches of Elite to sell themselves as more than just beautiful faces.

So what is it about Israelis that lures talent scouts from fashion capitals like Milan and Paris? “They have very strong characters,” explains Goddard, “maybe because of what they’ve been through living here. Personality is half the battle in this industry; it comes through in photos.” The long-time talent expert echoes what many have claimed about Israel’s deep pool of “talent”: it’s in the mixing.

A melting pot of immigrants from all over the world, Israel boasts an exotic blend of blondes, brunettes, and citizens of all shades and colors. The mass arrivals of Ethiopians and Russians since the 1980s has only increased the diversity of its populace. With nearly every look imaginable, Israel’s modeling industry can meet the needs of almost any talent agent; thus, an increase in demand from Elite and other international agencies.

Witness current stars Bar Refaeli and Esti Ginzburg. Refaeli, barely old enough to purchase alcohol in America, has already graced the cover of the fabled Sports Illustrated swimsuit issue. Ginzburg, not even old enough to vote in the States, has nevertheless appeared on the cover of the French Elle magazine and is already working throughout Europe and New York.

It appears that the sky may be the limit for young Israeli models, at least the ones deemed to be of adequate health. “We’re not just agents; we’re parents and psychologists,” said Goddard. “It’s not just our job to introduce these girls to industry. We need to guide them through it and agents need to take a stand and say no.”

With Barkan leading the way to say no, teenage girls and all of society will be the winners. And that is a real thing of beauty.

Eating disorders in the U.S. among ethnic groups were thought to be rare, but recent studies have shown that many cultures are now exposed to the thin beauty ideal. As a result, experts expect to see an increase in eating disorder symptoms among ethnic groups. It is also suspected that eating disorders and weight control behaviors may be increasing among adolescent boys. Although research has shown that eating disorders begin during adolescence, few epidemiological studies have been conducted with teens and those that have examined weight control practices among adolescents are too varied to be able to discern trends.

A new study, one of the first to examine trends in adolescent weight control behaviors over a 10-year period, found that the prevalence of these behaviors in male adolescents significantly increased, while black females appear to resist pressure to pursue thinness. The study was published online in the International Journal of Eating Disorders (http://www.interscience.wiley.com/journal/eat), the official journal of the Academy for Eating Disorders.

Led by Y. May Chao of Wesleyan University in Middletown, CT, researchers examined data from nationally representative samples of high school students from 1995 to 2005. The data was available via the Youth Risk Behavior Surveillance System (YRBSS), a survey conducted every two years since 1991 by the Centers for Disease Control and Prevention to assess the prevalence of health-risk behaviors among teens.

The results showed that the prevalence of dieting and diet product use among female adolescents significantly increased between 1995 and 2005 and as did the prevalence of all weight control behaviors (including dieting, diet product use, purging, exercise and vigorous exercise) among males. The data suggested that black female adolescents are the least likely to practice weight control, while white female adolescents are the most likely. Among males, white adolescents are the least likely to practice weight control and Hispanic adolescents are the most likely. The authors suggest that Hispanics may be more motivated to control their weight due to the higher prevalence of overweight among these young men.

The increase in weight control behaviors among males indicates that the social pressure for men to achieve unrealistic body ideals is growing, putting young males at an increased risk of body dissatisfaction and developing an eating disorder, according to the authors. “Considering that males have negative attitudes toward treatment-seeking and are less likely than females to seek treatment, efforts should be made to increase awareness of eating disorder symptomatology in male adolescents, and future prevention efforts should target male as well as female adolescents,” they state.

The study reported the 10-year trends but also showed that some behaviors fluctuated during this period. The authors suggest that some practices, such as dieting, may be sensitive to changes in certain aspects of culture, such as fashion and topics of media focus, or seasonal variations, since it was not known at what time of year the YRBSS was administered.

Surprisingly, unlike previous studies, the current study did not find that ethnic differences in weight control behavior are decreasing. The authors suggest that black women tend to have more flexible concepts of beauty, which may make them less vulnerable to social pressure. However, this may put them at increased risk for becoming overweight, given the current environment of super-sized portions of nutritionally deficient foods.

The authors conclude, “Males, especially ethnic minority males, are under studied in this field, and this study provides key information about the prevalence of weight control practices in a large, diverse sample of male adolescents and raises important questions about the factors contributing to the ethnic difference in weight control practices among male adolescents.”