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Thursday, Dec 7, 2023

Eating Disorder Clinic Takes New Approach

Marie has been struggling with starving herself while exercising excessively since her teens.

Now 21 years old and sicker than ever before, Marie, who didn’t want to be identified by her full name, said she’s hopeful a Swedish approach to treat anorexia brought to the Mandometer Clinic for Eating Disorders will be her doorway to normal eating.

Swedish scientist Cecilia Bergh used $250,000 from AB Mando, which is the Swedish parent company that Bergh founded in 1993, to open the first U.S. subsidiary, in Rancho Bernardo.

Bergh is the chief executive of AB Mando and its local unit.

Bergh helped develop the Mandometer, a computer program that teaches patients how to eat normally by tracking how much food and how quickly they eat.

The approach is a departure from traditional treatment methods, stressing psychotherapy and medications such as antidepressants.

Bergh says her clinic, which has eight employees, has achieved a 75 percent remission rate among its patients using the Mandometer, nutritional guidance and counseling.

Most patients tend to relapse, but Bergh says with the Mandometer approach, the relapse rate is 10 percent in the first five years.

“Eating disorders are very difficult to treat, afflicting more than 5 million Americans and more than 10 million people worldwide,” Bergh said.

Insurers Getting On Board

As of last week, the clinic, which opened in September, was taking care of six patients. Four patients have gotten so sick that insurers agreed to cover them. The contracts exist with Magellan Health Services Inc., Kaiser Permanente and PacifiCare Health Systems, said Leslie Mogul, a spokeswoman for the Mandometer Clinic.

Marie agreed to pay $50,000 out of pocket for a year’s worth of treatment.

Mari Blevins, office manager for the Mandometer Clinic, said she’s working with major health insurers to provide coverage.

Tyler Mason, a spokesman for PacifiCare of Cypress, said his company is in discussions with the Mandometer Clinic, but isn’t even close to signing a provider contract.

“It’s a different approach and a fairly new program,” Mason said. “We have providers that can service our members on these issues. At this point, it’s an ongoing casual conversation on what they have to offer.”

As a professor at the Karolinska Institute in Sweden, Bergh has been treating patients with the Mandometer since 1991 at the Center for Eating Disorders in Stockholm.

Teenagers are at the highest risk for developing eating disorders, she said.

Anorexia affects as many as 16 percent of U.S. females ages 14 to 24 and can take more than 10 years before patients improve, according to Bergh.

Anorexia also has one of the highest mortality rates among mental diseases due to the high suicide rate and medical problems from starvation, according to published reports.

Marie said she first heard about the Swedish program through literature and was impressed by the high success rate.

She realized that she had an eating disorder, but was never treated.

During the last 18 months, her weight had dropped so low that she decided to seek help.

Now, after more than two months in the program, Marie still finds it hard to accept the change.

“It doesn’t start with so much food , I went from eating nothing to eating six times a day, but when your metabolism kicks in, the system gets it,” she said.

Five-Year Plan

Dr. Louis Maletz, a family doctor and medical director at the clinic, said most patients require a year of active treatment, and then need to be followed for five years.

The good news is that doctors can usually predict outcomes within the first three months.

“We look for patterns of normal eating,” Maletz said. “If they (patients) start to show they can follow a normal eating pattern with the device, we get a good idea which patients will be a success and which ones will not.”

Bergh, who recently visited San Diego to drum up support for the Mandometer clinic through media outlets, is already planning for growth.

She explored alternative sites in San Diego to accommodate up to 50 patients in a combined inpatient and outpatient facility and apartments.

Part of the approach is to take patients out of their familiar environment, which Bergh says is conducive to ongoing “bad habits.”

She said many patients have developed compulsive-obsessive behaviors, such as excessive exercising or feverish cleaning, that new living arrangements can break.

Some doctors remain skeptical of the approach, but Maletz is a believer.

“There have been a lot of studies done (on eating disorders) and the success rates don’t look very good,” he said.

He hopes that the Mandometer approach will become the standard of care.

“I think it’s the most effective thing we have now. Ultimately it would be nice if we could cure people within a day or two, but we’re not there yet,” Maletz said.

Marie’s big hope is to return to college in April to continue her French and art history studies.

But she has no illusions about the seriousness of her illness, taking it one day at a time.

“My goal is to get to my goal weight (110 pounds) and not think about calories and what I am eating and listen to my body,” she said.

She just wants what every young woman wants , to be happy.


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