Nineteen ninety-one was a
big year for Dr. Mehri Moore. After six years as medical
director at the Swedish-Ballard
Hospital Eating Disorder Unit, she turned her duties over to a colleague, moved with her family to Mercer Island, joined the Bellevue Club and started The Moore Center, now in its 16th year of treating individuals with eating disorders. Mehri became interested in the treatment of eating disorders in the late 1970s when she was studying child psychiatry in
Philadelphia. During her tenure as a fellow in child psychiatry at the Philadelphia Child Guidance Clinic she became involved in a program that pioneered the use of family therapy as a primary means
of treating anorexic adolescent girls. Her experience as a member of the Philadelphia program inspired her to focus her studies and subsequent clinical experience on treating
patients with eating disorders. After completing her fellowship in Philadelphia, Mehri and her husband, a fourth-generation Washingtonian, moved to Seattle. The timing was good—at the same time, an
eating disorder unit was just starting at then-Ballard Hospital. Mehri began working there, and in a few months became medical director of the program, working with her team to develop the program into the
Northwest’s leading inpatient eating disorders facility. Mehri’s approach to eating disorders is derived from her experience in Philadelphia and her work as the medical director at Swedish Ballard Hospital. Patients at The Moore
Center participate in an intensive outpatient program that is a
structured program in a group format. It requires patients to attend meetings several times a week. In addition to the group work, they
are treated individually and with their families. The patients see
dieticians weekly for counseling and consultation. In addition, the dietician closely monitors the patient’s ongoing progress. The Moore Center treats people suffering from anorexia and bulimia, as well as those with binge-eating disorders and other
disordered eating patterns.
Eating disorders, says Mehri, are complex and many different factors have to be present for an individual to develop a pattern of disordered eating. “We know that eating disorders are more prevalent in societies that have plenty of food,” she says. Although culture is an important
factor in development of anorexia it is not the only factor. Eating disorders have been found in developing countries as well as in
the developed world, and have been around for longer than most might think. According to Mehri, the first recorded case of anorexia occurred in the ninth century. Bulimia is less common in counties with limited access to food. Bulimia is similar to addiction—patients are driven to binge
The Moores, Michael, Ben, Mehri and
Hannah, are pictured at
Hidden Valley Ranch in
Cle Elum.
and purge by using either
self-induced vomiting, excessive exercise or laxatives and diuretics. Much like addiction to a substance, the patients suffer from intense cravings, consume more than they desire and cannot stop during a binge. The purging is initially used in order to maintain a certain body size. In the later stages of the illness it becomes a way to cope and mange stress. Eating disorders evolve when
certain personal, familial and societal vectors converge. A young woman who is highly perfectionistic and compulsive, who comes from a family that values thinness and is highly achievement oriented, and who lives in a society that promotes a certain aesthetic has a relatively high risk profile. At The Moore Center Mehri has treated both multiple generations of women from the same family as well as multiple members of the same family. These disorders tend to begin in early adolescence when there is a lot of pressure and confusion surrounding changes to a young woman’s body; anorexic youngsters have great difficulty dealing with this change. “...it’s as if they want their old body back,” says Mehri. She also explains that youths are maturing earlier; consequently the onset of eating disorders is occurring in younger children, and occurring more often. “Eating disorders are more prevalent because there is more pressure in society to fit into a certain kind of of body type that is seen as more socially acceptable. This leads to dieting—and it’s the experience of dieting that precipitates (eating disorders) in individuals with a genetic predisposition.”
Warning Signs & What To Do
If you have children, no matter what their ages, there are steps you can take to help create a healthy relationship with food. Mehri says much of what parents can do is be aware of their own relationship with food, and seek help with any issues that exist. Parents should avoid emphasizing food and making it a center point for family life. Instead, make sure there is
a large variety of foods available, and let children
make some of their own choices about what
they eat. Family meals, says Mehri,
are also very important.
There are a variety of signs to watch
for in children that can signal disordered eating. These include:
•Cutting certain kinds of foods from their diet •Becoming too interested in food •Sudden behavioral changes, such as a sudden interest in exercise where there was previously no interest •Becoming too interested in magazines that emphasize certain body types •Sudden weight loss •A lot of talk about feeling fat or disliking certain parts of the body •Fascination with friends or celebrities that have disordered eating •Irritability •Sleeplessness •Frequent showers •Sudden change in neatness (messy to very neat and organized or vice versa) •Withdrawal from friends •Clinging to parents
If you are worried about your son or daughter, the best thing to do, says Mehri, is be honest with your child and help educate him or her about the dangers of eating disorders, much as you would if you were concerned with drugs, cigarettes or alcohol.
To treat her patients, Mehri has them participate in individual therapy sessions and group sessions with their peers. They also participate in art therapy, like a recent project titled “Fitting in your Genes,” where patients explored how they felt about their bodies by writing on blue jeans. In addition, families also receive therapy sessions, and individual patients and families meet with a dietitian. The Moore Center will also hold family groups, where patients and families get a chance to meet others in treatment. The variety of therapies, says Mehri, lets her and the other caregivers see patients from all sides. “We show different aspects of ourselves in different contexts,” she says. This way, the team can discuss patients from all angles. “You have that entire vision of that person and you say OK, these are the areas we really have to work on.” Circumstances that need to be addressed apart from the eating disorder, like marital problems or chemical dependency, which can hinder a patient’s recovery, are addressed as well. “I believe the best way to approach a patient is to give them an initial intensive treatment, then lower the intensity as they improve and move them to a step-down program,” says Mehri. Because these are chronic situations and potentially life threatening, inpatient treatment is sometimes needed. Once the patient has stabilized, she will still need to return to treatment to maintain recovery and prevent relapse. Unfortunately for Washington residents who require inpatient care, there is currently no dedicated inpatient eating disorders clinic in the state. Children’s Hospital does have an eating disorder track within their psychiatric unit, but the majority of adult patients are sent out-of-state for inpatient treatment. “I would say that somewhere around 15 percent of our patient population ends up going into some sort of residential or hospital setting,” says Mehri. She is currently involved in discussions with several institutions to explore the possibility of setting up a residential treatment facility locally; until then, patients requiring hospitalization go to California, Arizona, Utah, Colorado, Pennsylvania, Florida, Wisconsin or Louisiana. Recovery is a long-term process; it can sometimes take years for patients to recover. Relapse is common, and is considered a part of recovery. Mehri explains that the process of getting better includes several stages. The first stage is the pre-contemplation of the idea of recovery, followed by the actual contemplation. Eventually the patient will actually make a phone call to start treatment. Once she is in treatment, Mehri explains, “If you have an eating disorder it helps you to survive in your environment and works as a coping device. It’s hard to give that up emotionally.” Taking the steps to gain recovery eventually requires an emotional commitment. Relapse happens when a patient wavers from commitment to recovery and returns to contemplation. “… our work involves moving (patients) from contemplation back to the commitment stage, and ultimately to being emotionally ready to recommit to recovery,” Mehri says. “The good thing is once they make that commitment, it’s really satisfying to see change.” The hardest patients for Mehri are those that have multiple
problems: alcoholism or drug dependency on top of an eating disorder, or a severe psychiatric condition with an eating disorder. No matter who the patient or what their particular circumstances, Mehri says she learns a lot: “What I’ve learned is that we can’t really predict anybody’s prognosis or recovery. I’ve seen patients who had a severe eating disorder make this miraculous recovery while they’re in treatment. I’ve learned patience—looking at every person with a fresh eye and saying ‘this person has a chance.’” Mehri is consistently voted a top doctor by her peers in polls conducted by Seattle Magazine and Seattle Metropolitan Magazine. She says feels honored by the respect her peers have shown. “I think that it’s a validation and it helps our patients to have trust and sense that they’re in good hands,” she says. “Trust is a really important part of the recovery process.” During her 16 years at The Moore Center, Mehri has treated more than 3,000 people. Also during that time, she has raised two children, and still finds time to spend with her husband and at the Club. Mehri says she enjoys the Club because of the people she has met. Mehri and some other women have even formed a book club that meets once a month. She says they are always looking for more members. With her husband, she says she enjoys visiting with friends, going to movies and exploring the area’s restaurants. She and her husband are also preparing to go on a hike in the Alps toward the end of summer. “Its hut to hut, so we can get breakfast and dinner,” she says. Although she doesn’t always have a lot of free time, Mehri says she loves her work, and gets satisfaction at seeing changes in people. Sometimes, she says, she almost feels like she is part of the family. “I feel blessed in that I have that opportunity to be part of that experience.” For more information about The Moore Center, visit www.moorecenterclinic.com. Dr. Mehri Moore can be reached at drmoore@moorecenterclinic.com.
