After attending Punahou from grades 7 to 9, Dr. Kelly Vitousek '70 returned to campus in 1988 to conduct a small pilot study on eating disorder prevention. Now an associate professor of psychology, co-director of the Center for Cognitive-Behavioral Therapy, and director of the Eating Disorder Program at the University of Hawai‘i at Manoa, Kelly is a recognized expert on anorexia nervosa and related eating disorders. Her research interests extend to the effects of caloric restriction on longevity and a diverse range of extreme behavior patterns such as high-altitude mountain climbing.

How did you get interested in anorexia research?

I first read about anorexia nervosa while taking an advanced course in abnormal psychology at the University of Minnesota. My professor was an obesity and eating disorder specialist, who encouraged me to publish a paper that I had written on the topic as an undergraduate.

Why is anorexia nervosa an important topic?

Anorexia is a devastating disorder that has a profound effect on the lives of those who develop it as well as those around them. The symptoms are persistent in about half of anorexic patients, and 10 to 12 percent die from the disorder or through suicide. Anorexia remains quite rare in diagnosable form; however, any preventable pattern that causes such catastrophic effects in otherwise healthy young people merits serious attention - and I think that anorexia nervosa could be prevented and/or shortened in the majority of cases. Moreover, a substantially higher proportion of the population develops related eating/weight disorders that also cause considerable suffering.

Is it true that anorexia affects mostly teenage girls?

Yes, the typical age of onset is adolescence, most often between 12 and 18. The disorder can appear in younger and older individuals, and there are some indications that the period of vulnerability may be widening at both ends. There are several reasons why adolescent girls are at highest risk: they are undergoing rapid changes in size and shape, fat distribution, and hormone profiles while simultaneously experiencing major shifts in social relationships and in the standards used to gauge identity and self-worth.

Anorexia does occur in males ... often in those exposed to specific environmental pressures to control their weight, through athletics, occupational requirements (acting, modeling or dance), or dieting for obesity. Females in our society are all exposed to weight-related pressures, simply because they are female.

What can schools do to prevent anorexia and other eating disorders?

The most confident answers we can give relate to what not to do. There is no evidence that simply providing factual information about the symptoms and dangers of eating disorders helps to prevent these problems, and there are some indications that it can precipitate them. The pilot study I conducted at Punahou, many years ago, compared alternative prevention messages. Those findings and subsequent research confirmed the hunch that it is unhelpful to provide basic information about the nature and risks of eating disorders.

It is also inadvisable to present information about weight control or nutrition that focuses on limiting calories or avoiding "bad foods." It's not uncommon for eating/weight disorders to be triggered by well-intentioned school-based efforts to improve eating habits and prevent obesity. Unfortunately, such messages are often ignored by the majority of students and taken too seriously by individuals most prone to eating disorders. I'm not suggesting that nutrition information be dropped from the curriculum, but we do need to be more thoughtful about the ways in which it is presented.

The most promising interventions have used "dissonance" models. These models encourage students to argue against the thin ideal and/or promote healthy eating patterns without an emphasis on calorie counting or excluding of "bad foods."

It is highly desirable to catch eating disorders early and provide appropriate treatment. Individuals with a short history of anorexia nervosa at the time of initial intervention have a much better chance of making a full recovery than those whose symptoms have become well established.

Treatment services are available from the Eating Disorder Program of the Center for Cognitive-Behavioral Therapy at UH Manoa. For more information, contact Dr. Vitousek at vitousek@hawaii.edu.

Interview by Shiyana Thenabadu