Taking a bite out of a serious illness
Jordans help establish nation's first eating disorders professorship at Carolina

Transform a Barbie doll into a woman, and her measurements reveal a 39-inch bust, 19-inch waist and 33-inch hips. Transform that same Barbie into an average American woman, and those measurements become 37-31-42.

A startling dichotomy between fantasy and reality? Yes—and even more startling when you discover that thin, glamorous icons like Barbie are just one of the many powerful factors influencing the development of eating disorders.

“It was believed for a long time that (eating disorders) were socio-cultural, that somehow our culture or the emphasis on thinness caused anorexia,” said Cynthia Bulik, the William R. and Jeanne H. Jordan distinguished professor of eating disorders at UNC—the only endowed professorship of its kind in the U.S. and one of two in the world. “We now know that's just part of the picture.”

  
 

Eating disorders develop due to genetic and psychological influences in addition to the socio-cultural factors. They reveal themselves in diagnoses of anorexia nervosa, bulimia nervosa or binge-eating disorders (see box), and their treatment includes the work of psychiatrists, pediatricians, psychologists, dieticians, social workers, therapists and specially trained nurses.

Bulik welcomes the multi-tasking required to treat and control this insidious set of diseases. In addition to her professorship, she is director of the Southeast's first comprehensive eating disorders program at UNC Hospitals, and she intends to make it the best in the country.

“My vision is to make UNC a world-class treatment, training and research facility,” Bulik said. “We're aiming for the very highest level.”

Responding to a cry for help

The factors that brought Bulik and the eating disorders clinic to Carolina are as many and varied as those defining the disease. What set the events in motion was a mother's plea to save her dying daughter.

“It was 1996, and we were in the middle of a terrible snowstorm,” said Robert Golden, professor and chair of psychiatry and vice-dean of the School of Medicine. “A friend of the mother called Chris Fordham (retired chancellor and physician) who called me. He said there was a young woman dying of anorexia at Moses Cone Hospital in Greensboro and wanted to know if we had anyone who could treat her. We didn't, but I knew someone at an excellent eating disorders program at Cornell. We got the young woman on the last plane to New York before snow shut the airport down.”

The young woman lived and was eventually treated successfully. But the people who rallied to her mother's cry for help that snowy day wanted to do more: they wanted to bring an eating disorders program to UNC and launched a search for a director. “Although our original vision centered on clinical care, we realized that research and training components would make our program stronger,” Golden said. “We looked for someone who could lead all three missions. Only a few practitioners have dedicated themselves to the field. Dr. Bulik's name came to the fore quickly—and stayed on top.”

Supporters of the eating disorders program established the Anorexia-Bulimia Foundation of North Carolina and began to accrue donations. Senator John Kerr lobbied the legislature to fund the professorship: $400,000 was awarded with the stipulation that the gift be matched with private funds. Fayetteville physician, entrepreneur and UNC graduate Bill Jordan and his wife, Jeanne, responded with the needed money. When last-minute calculations revealed a $45,000 deficit, the Foundation of Hope, established by Thad and Alice Eure of Raleigh, provided the remaining gift.

“Without the Jordans' generous support, we couldn't have established the professorship,” Golden said. “Without the professorship, we couldn't have brought Cindy Bulik to Carolina. And without Cindy Bulik, we wouldn't have the outstanding clinicians, teachers, researchers and trainees who have come to Carolina to work with her.”

The Jordans share Golden's enthusiasm for Bulik. “My wife and I met her,” Jordan said, “and we think she's terrific.”

Spiders to weight gain, it's all about fear

As Bulik was accepting the Jordan professorship, the N.C. Neurosciences Hospital was remodeling a 10-bed inpatient unit to meet the needs of eating disorder patients. It opened in September 2003. Treatment in the unit is unique in that it is comprehensive, offering intensive inpatient care to day-patient care to outpatient care. All treatment has been proven effective in rigorous clinical trials. What Bulik brings to the program is also rare.

“She's a great example of what we call a ‘triple threat,'” Golden said. “She's a strong clinician. She is an outstanding teacher and role model who will help us train other clinicians around the state in current treatment practices, and she does groundbreaking research.”

Bulik, who received her bachelor's degree from the University of Notre Dame and her master's and doctorate degrees from the University of California at Berkeley, became interested in eating disorders while researching childhood depression. “I was asked to write a chapter on brain wave patterns during sleep in patients suffering from anorexia nervosa,” she said, “and I became fascinated with the disorder. It also gave me a context for problems that many of my fellow figure skaters faced in the 1970s. I had friends who had trouble with what I later found out was bulimia, but back in the '70s, there was no name for it and no treatment for them.”

   


When treating her patients, Bulik focuses on both their minds and bodies. “We take a cognitive-behavioral approach that helps people recognize their distorted thinking and replace it with healthier alternatives.”

She is compassionate yet firm.

“Gaining weight—which is absolutely the first step in recovery—is one of the most anxiety-producing interventions imaginable for these patients,” she said. “It is tantamount to having someone with a fear of heights dangle over the Eiffel Tower, or someone with a spider phobia have a tarantula on her head. We must understand how anxious our patients are about weight gain and empathize with that. At the same time, we need to be clear that without weight gain, these patients will never recover, and it is our job to help them through that very frightening process.”

Already saving lives

Since college-aged women comprise the greatest population of people with eating disorders, the program at UNC is poised to meet the needs of the area's three major universities and smaller colleges. Bulik's vision takes it much farther.

“We want to push the envelope in terms of developing newer, more effective interventions for these disorders,” she said. “We want to be involved in large-scale multisite clinical trials and incorporate new technology-enhanced approaches into our treatment. Finally, we hope to develop a subspecialty in treating athletes with eating disorders. The need is huge and there are no dedicated facilities in the country for athletes.”

The Jordans have pledged their ongoing partnership to make sure the program succeeds. Their initial gift along with those of others is already making a difference. “At the end of the day, the most important aspect of this program is that it has already begun to save lives,” Golden said.

Chrys Bullard

If you would like to make a contribution to the comprehensive eating disorders program at UNC, contact Crystal Hinson Miller at 919-966-9115 or hinsonmiller@med.unc.edu.