History and Overview
The WVU Disordered Eating Center of Charleston (DECC) was launched in the summer of 2010 by Drs. Stephen Sondike and Jessica Luzier. DECC is an interprofessional outpatient treatment program that provides services for youth and adults with disordered eating, including clinical eating disorders. Team members include psychologists, social workers, a registered dietician, and physicians specializing in adolescent medicine, psychiatry, and internal medicine. The DECC team meets weekly to discuss the progress of individuals receiving treatment and to review current research on the treatment of disordered eating. All team members have received extensive training in assessment and intervention with disordered eating patients, and utilize journal club, conferences, and continuing education opportunities to remain current in their knowledge and skills. Between meetings team members regularly collaborate to provide the most effective, evidence-based care for patients, and collectively address complex clinical issues.
In the Summer of 2016, the DECC underwent a time of transition because Dr. Sondike left his position at WVU. We began a new collaboration with the CAMC Family Medicine Center, located right next door to the WVU Department of Behavioral Medicine and Psychiatry. Patients are able to get all their needs met (medical, nutritional, psychological, psychiatric) in one place, and often on the same day or afternoon. We will continue striving to provide the most efficient and effective care for individuals affected by eating disorders in the future. As a replacement for Dr. Sondike is hired, we are hopeful to reignite our collaboration with WVU Pediatrics, located at CAMC Women’s and Children’s Hospital.
As outlined above, an interprofessional team format is used to address these highly complex disorders. Most DECC patients are treated in outpatient settings. Clinical services are provided at the WVU Department of Behavioral Medicine and the CAMC Family Medicine Center at CAMC Memorial Hospital. DECC psychotherapists use a variety of modalities in their treatment, including individual, group and family therapy. Therapeutic approaches include Maudsley, Cognitive-Behavioral, Dialectical Behavioral, and Acceptance and Commitment Therapy. Therapists work in tandem with psychiatrists, general practitioners, and a registered dietitian to tailor a treatment plan to each patient. Patients who are severely medically compromised may be hospitalized on medical floors at CAMC. In some cases, intensive treatment is needed on a specialty unit out of state. These decisions are always made collaboratively, with the patient and his/her family as pillars of the treatment team.
Awareness and prevention are major commitments for the DECC. Eating disorders remain stigmatizing and shameful in many cases. There is an imperative to increase public awareness and provide high fidelity information to counter the myths associated with these perilous medical and psychiatric conditions. One important charge of DECC is public education and awareness, especially with area schools and teachers. In collaboration with other contributing organizations (United Way of Central WV, Contemporary Youth Arts Company, The Greater Kanawha Valley Foundation, Charleston Area Medical Center's Civic Affairs Council) a mutual effort between DECC and a professional playwright (Daniel Keyde of CYAC) culminated in the creation of an hour-long play in 2011-2012. The play was used as a novel and time-effective way of providing information and experiences about eating disorders through the eyes of four teenage actresses. Dr. Luzier has also presented workshops on disordered eating for local educators and clinicians to raise awareness of the frequency and urgency of this problem, to highlight signs and symptoms and assist them in making assessments and necessary referrals. Team members regularly present to local physician groups and nursing students, among other groups.
In the Summer of 2013, with the help of undergraduate research assistant Morgan Mick, Dr. Luzier developed the WV Eating Disorder Network. Our goal was to develop a registry of providers across West Virginia who are interested in treating patients with eating disorders. We routinely disseminated information on trainings in the area and gathered information from providers for potential referral sources around the state. If you are a provider, and you are interested in joining the Network, please send an email to firstname.lastname@example.org. We now have close to 200 providers of all different disciplines with an interest in working with individuals with eating disorders in our state. Our listserve membership continues to grow every week.Dr. Luzier chairs a full-day conference for professionals in Charleston every spring, soliciting experts from around the country to help providers in West Virginia address the needs of this important population. The 2017 conference date is set for March 17 – mark your calendars!
Advocacy for Patients
We have a long way to go in West Virginia when it comes to improving access to best practice treatment for individuals with eating disorders. So much of our role is outside of the domain of the single patient or family we see in our clinics or schools. Dr. Luzier continues to work on advocacy efforts at the state and federal level and to disseminate information. Lawmakers continue to express discouragement to learn that there are no intensive specialized services for individuals with ED’s in our state: so patients and families must travel out of state to access an IOP, PHP, or residential level of care that provides specialty care for their condition. There are economic, social, and geographic factors at play here. We need to be developing programs that all patients can access, using best practices and offering intensive treatment.
During the 2015 and 2016 West Virginia Legislative Sessions, Dr. Luzier co-wrote a piece of legislation (along with a concerned father of a patient) that addresses the risks inherent in the “Fitnessgram” program that is enacted with all middle and high school students in our state. Middle and high school students in West Virginia are subject to mandatory “Fitnessgrams” in their health and physical education classes which require health or PE teachers to measure students’ Body Mass Index (BMI). While parents may receive general information about this program, parental consent for BMI measurement is not required in our state. There are multiple risks to students because of this practice including triggering dangerous and ineffective weight loss strategies in the children (diet pills, fasting, extreme caloric restriction, etc) and eating disorders, putting children at risk for bullying and teasing, and adversely impacting children’s self-esteem. Most importantly, there is no scientific evidence to suggest that BMI screenings in children are effective at combatting the health problems related to childhood obesity in West Virginia.
The WVU Disordered Eating Center of Charleston, in conjunction with the WV Eating Disorder Network have experienced firsthand the damage done by BMI screenings in schools. Children in West Virginia are being harmed by this practice. Furthermore, discussing weight and shape concerns with children while neglecting to factor in the context of a comprehensive medical, nutritional, and psychosocial evaluation will be ineffective at best and harmful at worst. The legislation that Dr. Luzier wrote seeks to bring the West Virginia consent process in line with best practice recommendations so that parents are able to make informed decisions about (1) whether BMI data is collected for their child and (2) by whom. The legislation is modeled after the Ohio consent process model, which allows parents to opt their child out of the BMI reporting process of the Fitnessgram program, or to elect for their child to have health status measured by a qualified healthcare provider. Once again, this legislation was introduced but then got stuck in committee this past legislative session. But we will continue to focus our efforts more diligently in years to come.
We’ve also been as supportive as possible with our partners the Eating Disorder Coalition to support the Anna Westin Act. Just to recap, this legislation provides training, prevention, and improved types of insurance coverage for eating disorders. Senator Shelley Moore Capito introduced this bill in the Senate in May 2015. A slightly different version was introduced in the House as well. Since then, it has gained bipartisan support. We now have unilateral support in the form of co-sponsors among all Congressmen from our state – McKinley, Mooney, and most recently Evan Jenkins. WV is on the map! In the fall of 2015, Dr. Briana McElfish (predoctoral psychology intern) visited Senator Capito in DC to present her with an award on behalf of the EDC. Both Senator Capito and Congressman Mooney have visited DECC as well in late 2015 and early 2016 – the team enjoyed tremendous meetings with them both.