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Ariana Chao: Leading-Edge Researcher on Binge Eating

The sushi restaurant Pod, a short walk from campus, may not seem the ideal venue for a lunchtime interview on eating disorders. “It’s one of my favorites!” Ariana Chao says. But plentiful food does not get in the way of discussion of her research on stress, binge eating, and metabolic abnormalities. Assistant Professor at Penn Nursing and the Perelman School of Medicine, Dr. Chao completed a Ruth L. Kirschstein National Research Award postdoctoral fellowship on an NINR-funded T32 titled “Research with Vulnerable Women, Children, and Families” in May 2017. She earned her BSN and MSN as a Family Nurse Practitioner at Boston College and her PhD in Nursing Science from Yale University. At Penn, she is seeking to identify the biobehaviorial mechanisms behind eating disorders, while developing innovative ways to improve treatments.

She also works as a clinician, providing medical management for patients in Penn’s Stunkard Weight Management Program and to participants enrolled in her research studies. We asked her to talk about her work and what led to it. —The Editors

 

Binge eating disorder was recently added to DSM-5, joining anorexia and bulimia.

What is binge eating? It’s defined as consumption of a large amount of food, combined with loss of control. The problem is, what’s objectively large? An adolescent might eat a lot without being out of control. But usually it’s pretty apparent, such as when someone finds themselves eating two or three dinner plates’ worth of food. The onset is usually late adolescence or early adulthood. And there’s a genetic relationship: If someone in your family is a binge eater, your risk of becoming one is double that of the general population.

The lay public is asking a lot of questions about how addictive food is. Among the research community, that’s highly controversial. A minority of people seeking treatment for obesity have binge eating disorder—no more than 20 to 25 percent. There has to be some kind of psychological stress for a diagnosis, some sort of guilt or shame.

Among many families with eating disorders, there’s a lot of emphasis on food or dieting at a young age. Sometimes there’s a stigma, or a bullying experience. We’ve found a lot of crossover among eating disorders.

I have three sisters. My family is very sweet-oriented. Females tend to be more sweet-oriented.

I was really into cheerleading as a kid. We went to national competitions. Cheerleading is a team sport where everyone has a different role, everyone has different strengths and weaknesses. In retrospect, that’s really good preparation for being on an interdisciplinary team in health research.

I first became interested in obesity when I was a cheerleader. I was competing from age seven in my hometown of Westford, Massachusetts. When I was a teenager, I saw some members of the squad developing eating disorder behavior. Then, as an undergraduate at Boston College, I had a research fellowship with a lab that looked at anorexia. And I’ve always been interested in primary care and prevention. I’ve wanted to be a nurse forever.

Because of my work as a clinician, I still have that patient interaction, which I love. I learn the most from my patients and what they tell me. I’ve been amazed at how much they’ve been willing to share.

The gold standard of treatment for binge eating disorder is cognitive behavioral therapy—interpersonal therapy that deals with the patient’s relationships with other people. It has worked with binge eating. But CBT doesn’t make them actually lose weight.

We focus a lot on behaviors and making small changes. At five percent weight loss, you start seeing metabolic changes. Then we work on ten percent, then fifteen. It’s one step at a time. Patients are with us for a year or more. The families are critical. Sometimes the spouses aren’t ready to make the changes necessary at home. We’ll work with patients to role-play having conversations with their families.

I’m developing a course for the spring on obesity treatment. It’s an interdisciplinary course that includes medical students as well as nursing students. We’ll be looking at lifestyle counseling and doing a look-ahead study, focusing on stress management and portion sizes. And we’ll be role playing.

Nurses have really broad training, looking at the community and at interpersonal dynamics, what’s happening with the patient’s family. I hope in my lifetime that our profession can see a decline in obesity. Prevention will be the primary factor, helping individuals have healthy eating become more automatic. Reasonable portion size. And instead of picking chips, have kids automatically pick something better. Having a healthy default. And making cities more walkable would be a huge help.

Being in nursing research as well as a clinician means you’re helping to make the world a better place in a way that’s translatable, that can be implemented into practice. All while discovering things that will help people.

 

— Ariana Chao PhD RN CRNP