The Man Who Looks Inside Anorexics’ and Bulimics’ Minds

When Walt Kaye first took on a study of anorexia during a fellowship, he had never met anyone with an eating disorder. Thirty-two years later, he is writing the definition for what “eating disorder” means.

Kaye is the director of the Eating Disorders Program at University of California, San Diego, and he’s helped lay the groundwork for a new way of looking at eating disorders. He refutes the idea that anorexia and bulimia are caused by bad parenting, family environments or even super-skinny fashion models.

Instead, his use of genetic testing and brain imaging has produced evidence that the disorders are biologically based, meaning they likely exist in a person’s brain at birth.

“There is absolutely no data showing that families cause anorexia, except maybe by sharing their genes,” Kaye said.

His research points to disturbances in a person’s brain that could cause them to ignore hunger signals or reduce their drive to eat. The implications of those findings are wide reaching.

If Kaye can conclusively show how the wiring in an anorexic’s or bulimic’s brain is broken, he hopes he will also be able to figure out a way to fix it, whether through medication or more focused therapy. And beyond that, he hopes that proving that anorexia and bulimia are biologically based will remove much of the stigma surrounding the diseases, which he thinks will encourage eating disorder sufferers and their families to recognize and better understand the illnesses.

“It’s a very difficult disorder to treat,” he said. “Anorexics don’t see themselves as having a problem, don’t see themselves as being too thin, don’t want to gain weight, and think they are fine just the way they are.”

Despite this difficulty, Kaye said he was drawn to working with and studying anorexic patients, as well as bulimics, partially because he identifies with them.

“I’ve never had an eating disorder, but some of the traits that people with eating disorders have, like perfectionism and achievement orientation, I have traits of that myself,” he said. “So I found it fascinating to understand more about those traits.”

Kaye, who left the University of Pittsburgh to join UCSD in 2008, has written more than 300 articles on eating disorders and their treatment. He’s received just under $1.2 million in federal grants for three different research projects since 1988. His colleagues consistently refer to him as a leader in his field.

Despite Kaye’s empathy for his patients, scientific curiosity remains the main motivation behind his research. When he began that study of anorexia during his fellowship at the National Institute of Mental Health in 1978, he had never treated anyone with an eating disorder, but quickly realized the disease’s potential for assisting biologic discovery.

“I was fascinated by it, because people who are suffering from it resemble each other much more than in any other disorder,” he said. “I thought this would be a good way to understand how the brain works, why people with anorexia act the way they do, and to learn about the brain.”

This potential for discovery continues to drive Kaye’s research.

He now uses brain scans to look at the responses to food in anorexics’ and bulimics’ brains. These studies hypothesize that disordered eaters don’t experience hunger in the same way most people do and either feel too much or too little reward when they eat. Through this research, Kaye has found evidence that suggests that anorexics feel less hunger and less food-related reward than most people, while bulimics feel more hunger and more reward.

To do this, Kaye recruits women who have had anorexia or bulimia in the past, but who have now returned to a normal weight. His subjects spend up to four days in his research center on the UCSD campus, and sometimes undergo 12-hour fasting periods to heighten their brains’ responses to food. He then gives some of the women plain water or sugared water and scans their brains to look for a change in the activity of chemicals or stimulation in parts of the brain that control feelings of hunger and fullness.

Nancy Zucker, the director of Duke University’s Center for Eating Disorders, called Kaye “a pivotal figure” and said his work has paved the way for much of the brain-based eating disorder research being done today, including her own.

Zucker also said she appreciates his cautious nature when he presents his results. Although it might be tempting when you’re at the front of your field to make sweeping claims, Zucker said, Kaye doesn’t overstep his bounds.

James Lock, the director of the Child and Adolescent Eating Disorder Program at Stanford, also said Kaye sits at the top of his research field. Lock cautioned that although Kaye has gathered significant chunks of information about the biology of eating disorders, the whole picture has not yet been filled in.

“He’s gathering bits and pieces, and is making a probable story out of it,” Lock said. “It’s not exactly the same story I might tell, but I like his story. It has to be filled in, and that’s what he’s trying to do.”

Because most of the studies Kaye has done are on a small scale — often using only 50 or 60 women — they are not definitive, a fact that Kaye readily admits.

“There is still more to be done to confirm our conclusions,” he said.

Thirty-two years after his first encounter with eating disorder patients, Kaye is pushing for those confirmations. He made the switch to UCSD because of its neuroscience community, which he said is “as good as, if not better than, any place in the country.”

He said he also wants to expand his program’s services to the San Diego community to “give back” to those sufferers he’s working to understand.

The center offers several outpatient treatment options, including week-long intensive family therapy and 10-hour day treatments with three supervised meals. On Sunday, Kaye will also join his research subjects, patients, and others who have suffered from eating disorders at San Diego’s first-ever National Eating Disorder Association Walk in Mission Bay.

Whether Kaye’s work will help alleviate or even cure these disorders is not yet clear, but the contributions he has made so far have already brought more understanding for those who suffer from anorexia and bulimia.

“They can at least know that it’s not their fault,” he said.

Claire Trageser is a San Diego-based freelance writer. Please contact her directly at claire.trageser@gmail.com.