All the treatments used in the Mando program are evidence based, and the data supporting these treatments have been published in the most prominent peer-reviewed biomedical journals, including the Proceedings of the National Academy of Sciences and the British Medical Journal. All eating disorder patients are followed up for five years and we regard the efficacy of our treatment only in the light of their long-term success.
We invite you to read our publications, which are accessible in PDF form at our website.
Vistit the Media Archive
Our research shows that people who are at risk for food-related problems have a common issue; those individuals are unable to recognize either hunger or satiety. Therefore, people who become overweight or obese eat when they're not hungry and continue to eat meals well in excess of their point of satiation. Those who become anorexic or bulimic try to avoid eating in order to avoid overeating, since they know that they are not able to control their food intake. Similarly, binge eaters tried to restrict their food intake as long as possible until they are ravenous and overeat in the absence of any control over their food intake.
The good news in our findings is that these individuals, whom we call linear eaters because they do not slow their food intake over the course of a meal, can be retrained to recognize and act on their feelings of hunger and satiety to regain the ability to eat normally and to sustain a normal body weight. We use electronic aides to facilitate this relearning procedure that allowed these individuals to model their abnormal eating pattern to a normal pattern.
One of these devices is called a Mandometer®, and it is designed to weigh the plate during a meal and record a decrease in weight as the food is being eaten. In this way, it can show a patient his or her rate of eating in comparison to the rate of eating of a group of people who eat normally. Similarly, the device allows individuals to record their development of satiety over the course of a meal and model the rate at which it is developed compared to that of a normal group. If you eat too quickly, the device tells you to slow down and if you eat too slowly, this talking plate tells you to speed up.
This training technique gradually allows patients to reclaim their normal patterns of eating by regaining their ability to recognize hunger and satiety. Once they are in control of their food intake, the obese lose weight, those undergoing bariatric surgery have no side effects, and those with eating disorders no longer have psychiatric symptoms and they are able to live life at a normal body weight.
Treatment Goals for Eating Disorders
We adhere closely to the American Psychiatric Association Treatment Guidelines for Eating Disorders (shown in boldface)
• Treat physical complications.
Our first priority is to treat all of your physical complications, and to do that, first stabilize your medical situation and then we take measures of your physiological status throughout your treatment. You will have a completely normal physiological status at remission.
• Treat associated psychiatric conditions, including defects in mood regulation, self-esteem, and behavior.
Our caseworkers talk extensively to each patient to calm them, to build up their self-esteem, and to support them as they gain the courage they need to start learning to eat normally.
• Provide family counseling and therapy where appropriate.
We include the family in discussions of the treatment and we educate them about how individuals develop an eating disorder, as well as how our treatment leads to a remission and recovery.
• Prevent relapse.
We are unique among providers of eating disorders treatments, not only because our treatment is significantly more effective than the others, in reaching remission, but just as importantly, 90% of our patients who go into remission remain there five years after the termination of their treatment. Such long-term efficacy is unique among eating disorders treatments.
• Restore or maintain healthy weight.
The critical focus of our treatment is to ensure that our patients restore their normal eating patterns, which gradually will ensure that they will maintain a normal healthy weight. Once normal eating patterns and normal body weight return, we find that all psychiatric symptoms also normalize.
• Minimize food restrictions.
One reason that individuals develop an eating disorder is that they eliminate various foods from their diet, regarding them as forbidden or taboo foods. We work hard to ensure that our patients eat all foods and that there are no foods that forbid themselves to eat.
• Reduce binge eating and purging behaviors, if present.
We reduce binge eating and purging by making sure that our patients eat regularly. If they are eating three meals plus two or three snacks during the day, they will not become ravenous, they will not binge, and they will not purge.
• Provide education regarding healthy nutrition and eating patterns.
We provide all of our patients with detailed information regarding healthy nutrition and normal eating patterns. Indeed, the central aspect of our treatment involves the normalization of eating patterns and the development of healthy nutrition.
• Encourage healthy but not excessive exercise.
We encourage patients to engage in the limited physical activities that allow them to recover from their disorder.
• Enhance the patient’s motivation to cooperate and participate.
The central role of our caseworkers is to increase the patient's motivation to become well again and to participate in their own recovery.
• Address underlying themes and correct core maladaptive thoughts.
Our caseworkers stress the importance of becoming well again, the importance of eating normally, and the importance of correcting maladaptive thinking to overcome their illness.
• Determine an initial level of care or change to a different level of care based on an overall assessment of the patient.
We determine the initial level of care that is needed for each patient, ranging from full-day to partial-day to hour-long outpatient visits. A detailed assessment of the medical status, psychiatric status, and eating status is done initially and then regularly repeated over the course of their treatment.
• Consider full-day outpatient care for patients with the following indications:
• Partial motivation to recover.
• Preoccupation with ego-syntonic or -dystonic maladaptive thoughts.
• Need for structure to gain weight.
• Need for structure to prevent compulsive exercising.
• Presence of comorbid psychiatric conditions requiring intensive treatment.
Many of our patients start treatment as full-day outpatients in our clinic because they require that level of treatment, as they have the above indications.
• Establish goals for seriously underweight patients.
Each patient has an initial goal weight and a final goal weight, which brings them into the normal body weight range.
• Restore weight.
Body weight is restored by training patients to recognize normal hunger and satiety cues, to eliminate forbidden foods, and to eat a normal amount of food at a normal rate, several times each day. Once normal eating patterns are restored, normal body weight develops as its consequence.
• Normalize eating patterns.
The central element of our treatment program is that we normalize eating patterns in our patients. Once normal eating patterns are reestablished, all symptoms of anorexia and bulimia resolve.
• Achieve normal perceptions of hunger and satiety.
We normalize eating patterns by normalizing a patient's perceptions of hunger and satiety. We facilitate this process by the use of the Mandometer®, which shows the patient’s rate of eating and development of satiety on the same monitor as the normal eating pattern of normal-weight individuals.
• Correct biological and psychological sequelae of malnutrition.
We correct the biological and psychological sequelae of malnutrition by training our patients to eat normally. Before they are eating normally, however, we may have to supplement their diet with a feeding tube, or with dietary supplements to get them to a normal nutritional status.
• Help the patient to resume eating and to gain weight.
The central aspect of our treatment program is to help our patients resume eating normally and thereby allow them to gain weight.
• Help the patient to maintain weight.
By teaching them to eat normally, patients who have reached remission are quite capable of maintaining their body weight.
• Establish goals.
All our patients develop specific goals for the normalization of their social behavior.
• Establish and maintain a psychotherapeutically informed relationship with the patient.
Our caseworkers maintain a consistent long-term relationship with each patient - an individual caseworker works with an individual patient throughout their treatment. They can spend hours a day discussing importance of re-establishing their health, helping them overcome their fears, helping them to increase their self regard, and helping them overcome any problems they have in re-establishing normal patterns of eating.
• Provide formal psychotherapy once weight-gain has started.
We find that our patience normalize the psychiatric symptoms as they gain weight and formal psychotherapy has not been needed for any of hundreds of patients we have treated.
• Use psychotropic medications in conjunction with psychosocial interventions, not as a sole or primary treatment for patients with anorexia nervosa.
We do not use psychotropic medications as the sole or primary treatment for patients. Indeed, these medications are ineffective in treating either the psychiatric symptoms associated with anorexia or bulimia or the disordered eating pattern that characterizes these disorders. We also find that these medications slow the recovery of our patients, since they must be withdrawn gradually, as they often suppress food intake.
• Whenever possible, defer making decisions about medications until after weight has been restored.
We always defer decisions about initiating psychotropic medications until after the patient’s body weight has been normalized. At the same time, once normal body weight has been re-established, we find that none of our hundreds of patients that we have treated require these medications to re-establish a normal psychiatric status.
• Be aware of and manage general side effects.
We are careful to monitor all drug consumption and we are very aware of side effects including those associated with a rapid withdrawal of psychotropic medications. Therefore all psychotropic medications are gradually withdrawn under the supervision of a physician.
• Consider antidepressants to treat persistent depression or anxiety following weight restoration.
We have not considered the use of antidepressants following weight restoration because depression is alleviated following the normalization of eating behavior and the normalization of body weight.
• Consider second-generation and low-potency antipsychotics for selected patients with severe symptoms.
All antipsychotics have been used for eating disorders, but none has been shown to have any efficacy for their symptoms.
• Establish and maintain a therapeutic alliance.
Our caseworkers work very closely with each patient to establish a therapeutic alliance.
• Collaborate with other clinicians.
There is close collaboration among clinicians on our staff and they work closely with our dieticians and our physicians to offer an integrated treatment to every patient.
• Assess and monitor eating disorder symptoms and behaviors.
We assess and monitor all symptoms of eating disorders on regular basis.
• Ensure that the patient’s general medical status is assessed and monitored.
The general medical status of every patient is assessed and monitored regularly. Their treatment is coordinated among our entire staff.
• Assess and monitor the patient’s psychiatric status, including co-occurring conditions and safety.
Every patient has their medical status assessed initially and at regular intervals. We also assess any co-occurring conditions with particular regard for their safety.
• Assess family issues and enlist family support.
We discuss both the development of eating disorders and their treatment with family members. We then enlist their support for the recovery of their child. We also show them how to maintain the recovery of the child once they are back at home. We also have developed parent groups to help them provide that support.
• Provide education about the patient’s eating disorder and its treatment.
We provide extensive education to each patient about the nature of eating disorders, how they are developed, and how we are treating their disorder.