(bright music) - Hello and welcome to Prairie Pulse, coming up a little bit later in the show.

We'll profile Minnesota filmmaker Melody Gilbert, but first joining me now is our guest, Dr. Steven Wunderlich.

Vice-president and chief of behavioral health research for Sanford research.

Thanks for joining us today, sir.

- Thanks for having me.

- As we get started, we always ask, tell the folks a little bit about yourself and your background.

- Sure.

Well, I'm a Fargo-Moorhead boy born in Fargo, grew up in Moorhead, and then I moved away to the University of Missouri, where I did part of my training.

And then I went on to the University of Wisconsin where I completed my training.

And then I came back here in 1987 and took a job in the University of North Dakota- Department of Psychiatry, where I worked for 32 years.

And just three years ago, switched over to Sanford on this new position, although I've always been affiliated with Sanford and ran a clinic and hospital program there for a long time.

- Well, we're here today to talk about eating disorders and, but I understand that you you've received or Sanford has received a new multi-million dollar grant to study some of this.

Can you tell us about that?

- Sure.

- And what's it about?

- Sure.

No, we're very excited about it.

It's a big deal for Sanford.

We think it's a big deal for the region, too.

It allows us to do some high level clinical research that we couldn't have done without it in collaboration with NDSU and UND.

And it's all focused on eating disorders, eating behavior.

And that allows us to also get into the study of obesity.

And we're gonna be able to do some very sophisticated studies.

We've got about 40 people working on this from the region, but also from around the country.

And then we have five, what we call early career investigators, people who are relatively early in their scientific or academic careers, and they're doing some of the science in this project.

We have a variety of support services, training programs, funds that we can deliver to the community for pilot projects.

So it's, what's called an infrastructure grant or a center grant, it's designed to build a center of excellence.

The name of the grant is a COBRE, Center of Biomedical Research Excellence.

- Yeah.

So, so how did Sanford receive the grant?

And why?

I mean, you went, why, you know, you're doing the research.

- It's a good question.

Me and a significant number of people worked for a couple of years on this.

We began in 2019, and then we put in an application, we put in another one in 2020, which we thought was an improvement.

And then we learned this year that they decided to fund it.

They thought it was good enough to fund.

They thought it was innovative.

And they were pleased that it was up here in North Dakota, South Dakota, and they were, and they funded it.

So, that's how we got it going.

- Yeah.

You mentioned partners in this, NDSU and UND.

How exactly do they fit in?

- We've got a team of 15 scientists here in Fargo that work at Sanford research.

We needed some other personnel and we have a lot of good collaborations at NDSU and at UND.

And we got everybody together.

We started working together.

We drew up a grant that would cover all three institutions, and we needed some of the services that they had at NDSU and at UND in terms of laboratories, in terms of particular types of expertise.

So, actually it was a great fit.

Some of the things that Sanford didn't have NDSU, or UND did, and vice versa.

So, you put it all together.

And it's kind of like having a major Metropolitan University Medical Center working together on this project.

- So, will there be a test subject involved or clinical trials and things like that?

- We aren't gonna be doing clinical treatment trials in the first five years of the project.

The way it works is you.

We got funding for five years, and then after five years, we'll be able to try and get a second five-year interval.

And then there's an opportunity to get a third five-year interval.

So, it can be 15 years total.

In the first five years, we're gonna be doing more basic studies looking at how do eating disorders develop?

How do they operate?

What keeps people stuck in them for so long?

And why are they so hard to treat?

So, we're gonna be studying what we call the basic mechanisms of eating disorders.

And what we proposed is if we get funded in the second five years, we wanna take what we learned in the first five years and use it to enhance the treatments that we have for eating disorders.

And see, then if we can make better treatments at the Sanford Center for Biobehavioral Research, which is where this is based, we have done randomized controlled trials, treating different groups of eating disordered people for many years.

And with this new infusion of data, we think we could maybe enhance the treatments we have and hopefully they'll turn out better.

- Yeah, so are there three main types of eating disorders, and what are they?

- In the American Psychiatric Association system, The DSM-V, there are three primary eating disorders, anorexia nervosa, which is the starvation syndrome that many people know about, people get very thin, very emaciated preoccupied with thinness.

There's another disorder called bulimia nervosa, which is the binge-purge disorder.

Oftentimes it's people that do try and pursue thinness, but then they'll have what we call breakthrough binge eating episodes.

So, they'll try and eat as little as possible, but then they'll eat a tremendous amount of food in a short period of time.

And then they engage in a variety of behaviors to try and get rid of the food, vomiting, laxatives, diuretics, diet pills, et cetera.

The third disorder is called binge eating disorder, and that became an official diagnostic condition in 2013.

And it's of the three eating disorders.

It is, it is the most common, and it affects a broader range of people.

Whereas anorexia nervosa and bulimia nervosa might affect young women, girls, some boys and men, but mostly tip toward females.

Binge eating disorder seems to be equally distributed across genders.

And it also affects older people.

So binge eating disorder is, again, losing control of eating, gaining some weight, usually because there is no vomiting, no laxatives.

So, it seems to be associated with obesity, which is another serious problem in and of itself.

- So, what is binge eating and just, I mean, or is it just, I mean, you may think, well, binge eating, you're just eating.

- Yeah.

We've got a lot of technical things.

People like me come up with interesting definitions sometimes.

The way we look at it is it's eating a large amount of food, larger than most people would eat.

So, it could be 3 to 5,000 calories in two hours.

And when it's happening, the person feels like they're out of control.

They cannot stop it.

They feel like somebody has sort of taken over their, their body in a way.

So, it's eating a lot of food in a fashion that clearly is out of control.

It's a very unpleasant experience for the people who do it.

- Well, you mentioned "hard to treat," I think just a moment ago.

So, why are these hard to treat and recover from?

- That's a good question.

That's part of why we wanna do these studies.

We know a lot about these disorders.

Anorexia nervosa has been around for centuries.

Bulimia nervosa has only been diagnosed since the '70's, and binge eating disorder is relatively new.

So in a way, although we know a lot more than we did 50 years ago, we still don't understand the basic nature of them.

They're complicated.

They're multifactorial, there's clearly a role of biology.

There's clearly a role of psychology.

Genetics are important, but there's a huge role of culture.

Eating disorders tend to happen more often in certain cultures than others, especially if the culture has sort of a emphasis on appearance and thinness and that sort of thing.

So, these are complicated conditions.

There's a lot going on.

And the people who are trying to get better from them to recover, it's a struggle often.

And they're just very tough conditions.

It takes years sometimes to recover.

- Did you or the staff to see a spike in eating disorders during COVID?

- Yeah.

In Fargo here at the Sanford Eating Disorder and Weight Management Center, which is the clinical companion that we have for this grant.

In that center, they treat eating disorders, they treat obesity, they treat people after bariatric surgery.

So, it's all about feeding and eating and things of that sort.

There was certainly a surge in people looking for help during the pandemic, I'm on a National Board for an Eating Disorder Association, same thing.

They have a call line.

Their numbers have been up higher than they've ever been up.

It's very similar to what the CDC has put out for us in terms of depression and anxiety.

Definitely elevated over 2019.

- So, I was gonna ask, why do you think has happened?

Is it that depression and anxiety is that...?

- That's part of it.

Eating disordered people oftentimes have depressive episodes or anxiety and suffer from that, which might in some way complicate their eating disorder.

I think the other problem was people with eating disorders when they're stuck in their homes.

So when we were all in our houses, trying to be safe, that's a really tough environment for people, for people with eating disorders, especially if you know, anorexic people they're trying not to eat.

And now they're locked in their house with their kitchen.

People with binge eating, the kitchen is right there.

The refrigerator is right there.

So, it put them in a very difficult environment.

- You mentioned women, I think it skewed toward women, women having the eating disorders.

Why is that?

- It's a good question.

We don't know all the answers to why there seems to be a tip more toward women for anorexia nervosa and bulimia nervosa.

But I do think it's, it's reasonable on the face of it.

The idea that there's more cultural pressure for women to be thin, to pursue dieting, to achieve a very low body weight.

It's different than it is for men.

Men have some of their own pressures in terms of muscularity and seeking sort of the cut physique, but there's been a long standing pressure for females in particular to pursue thinness and to avoid being overweight or fat.

And I think that's gotta be part of the explanation for the gender difference.

- I understand.

And some of this, your research will delve into how the brain works in relation to how it reacts to food and why some people are more susceptible to being afflicted by the eating disorder.

Can you comment on that?

- Yeah, certainly in the last 20 to 30 years, we have the decade of the brain and all of that NIH put a real emphasis on studying the brain for mental health and behavioral health problems.

One of the things we learned is that eating disordered people seem to have neurocircuitry, which might function a little differently than other people, especially in terms of food and thinness and the kind of things they struggle with.

Their brains might get activated in particular ways, which makes it very difficult for them to change their behavior.

We're gonna do some of that work.

We're gonna do one study in our COBRE project, which does do brain scanning and looks at eating disordered people when they're in particular situations.

So, we can understand how the brain works.

We're also very interested in something called reward processing.

And one of the things that we think a lot about, similar to alcoholism and substance use is that there's something about eating disorder behaviors, which even though they're distressing to the person overall in the moment they're rewarding.

It could be that binge eating or exercising excessively helps their brains to feel a little less bad.

And somehow that might be part of why they keep doing it.

It works for them to improve their life a little bit, but then the long-term consequences catch up.

- I think maybe some other areas you'll be researching, risk factors and predictors of eating disorders.

- Yeah.

In the first phase of the project, we aren't gonna do a lot on risk factors, that requires you to really study children and young people before they have the eating disorder and then follow them up over time to see what does predict the onset of a disorder in some people.

We hope to do some of that in the second phase.

That's wonderful work because it allows you to begin to think more clearly about prevention programs.

We're gonna be looking more in the first part of our COBRE, in what we're calling maintenance factors, as opposed to, you know, risk factors.

And those are the things that in people who have the disorders, what predicts getting better versus staying stuck in the disorder?

And once we understand what's got people stuck, then that'll help us to target our treatments more effectively.

- Well, what about eating disorders behaviorally in different populations?

What do you know about this and what do you hope to learn?

- Well, it's a very interesting question.

So, there are gender differences.

We don't know a lot about eating disorders in men and boys, although maybe 10% of the eating disorder population is male.

We also don't know a lot about eating disorders in minority groups, racial and ethnic minority groups.

For example, one group, we don't know a lot about are American Indians.

We would like to include a significant number of American Indians in our studies.

So we can begin to try and understand, are there particular aspects of that group, which kind of differentiate them from other groups?

So, we have a lot to learn about in terms of subgroups.

- How are... (coughs) Eating disorders linked to of course health related behaviors?

- Well, yeah, this is where, this is where the rubber meets the road here.

The most serious psychiatric disorder in terms of lethality and mortality is anorexia nervosa.

The only thing that may surpass it is opiate dependence.

So anorexia nervosa in the most basic way, not only affects your overall health, it affects your ability to live.

Bulimia nervosa on the other hand, is a disorder which can complicate organ systems, top to bottom, from your teeth to your GI track, to your blood pressure, to everything else, and binge eating disorder to the degree that it's tied to obesity.

It comes with all of the risks that come with obesity.

So, all three of these disorders are medically significant, serious conditions.

- Can you talk about how difficult it is for family members to live with someone who has an eating disorder?

- Yeah, for years when I was working in the clinic, one of the things I did for the clinic was I ran a family support group here in town.

And I met with families every Monday at 5 o'clock.

And whether it was the family's child, or a spouse, or a mother, or a father who was the patient, I met with the families and most of what we did was just hear each other's stories and try and figure out was there anything we could do to be helpful?

And what I can tell you is eating disorders are real scary for family members.

It's not just the risk of death, it's the complexity and the difficulties that the patient is going through in the family home, around food, around family meals, around getting along with people.

It's very difficult.

It's a very tense environment for the patient, parents, siblings, the whole group.

- Yeah.

Is there a magic cure or treatment down the road in treating eating disorders or you're hopeful this research might inch towards that day?

- I'd love a magic cure.

I'm probably not gonna get my way on that, but I do think, I do think we could come up with some better tools, for example, anorexia nervosa, whether you're using behavior therapies or drug therapies, if you're 18 years or older, there's no scientifically proven effective treatment.

So, there's a great opportunity to enhance the quality of treatments there.

There's new, what are called neuromodulation techniques, brain activation techniques, which might be very helpful.

And hopefully we can learn about them.

So, we hope that ultimately we'll be able to change our little black bag of techniques to help our patients get better faster.

- We're about out of time.

So, what do you hope the long-term goal will be for your COBRE grant?

- Well, we hope that we do good work.

We learn things.

We share it with the professional audience that we work with every day.

We make better treatments.

We serve our patients, and we'd like to keep it going for 15 years.

- So 15 years you think so, okay.

Finally, if people do want more information about this or about eating disorders where can they go, who can they contact?

- If they're interested in the COBRE in any way, contact the Sanford Center for Biobehavioral Research, which is in Fargo.

If they have a concern about themselves or a family member, a loved one, who's suffering from an eating disorder, contact the Sanford Eating Disorder and Weight Management Center, South University Fargo.

- Okay, well, thanks so much for your time today.

- You bet.

- Stay tuned for more.

(bright music) Based for much of a career in Minnesota, award-winning documentary filmmaker, Melody Gilbert has a unique talent for profiling subjects who may not fit into societal norms.

She hopes her films, spark discussion, and maybe even an understanding of those she profiles.

(sound of film rolling) - My name is Walter Mondale.

Does this mean anything?

- I'm looking for the thing around the thing, because the thing is interesting, right?

Like, that is interesting, but it's the thing around that thing that's really interesting.

I actually am not like most people where I was movie fanatic, I was a story fanatic and I was a journalist, a working journalist for 15 years.

(wind blowing) Melody Gilbert Newsline Nine, Nielsville.

I never went to film school.

A lot of people know that about me.

I teach in journalism and film programs, but I never went to journalism school or film school.

(indistinct) And I learned by doing.

I was on a shoot, and as soon as the camera went off, and as soon as the big cameraman left and that sound person went away, the person started telling me things that they wouldn't tell me when the camera was on.

And I thought, oh, that's what I wanna do.

I wanna spend more time with people.

I wanna spend more time, get to know them better, learn the stories more.

♪ Going to the chapel and we're gonna get married.

♪ - My very first independent film was called "Married at the Mall," and I decided I needed to do something that was close because I was living in St. Paul.

I'm like, oh, the mall is 10 minutes away.

And I decided I was gonna spend a year doing something instead of a day.

- "Every kind of diversity you can possibly imagine."

- I spent a year filming weddings there, and making a lot of mistakes.

So I did a lot of, you know, the camera work myself, but I work mostly with a wireless microphone and I had a ton of audio problems.

I had a ton of, you know, video problems from the camera.

And I just learned by making a lot of mistakes.

I really didn't understand the business side of making films.

I just immersed myself in that world.

And I started going to a lot of film markets and film festivals and meeting all the film people.

I'm really honored to receive this award...

It is at that point, that I started realizing, oh, there was a whole business of independent film.

Okay.

So, (indistinct) "A life without Pain" took about a year to make.

The most successful film I ever had, that made me think I could actually be in the business and stay in the business for a while, was "A Life Without Pain."

- People always think of pain, pain, pain.

Oh, if I could get rid of the pain, I'm thinking you do not even know how lucky you are that you can feel it.

- I just wanna know why people do the things they do.

So when I heard about people who want to be an amputee, and I mean, I'm going to say that again because it's like, they want to be an amputee.

Like, really?

I kind of just needed to go find out.

- About the only way I would get through a day is looking at that longingly for some time.

That's the only way I can get through the day.

I'm a person that has a right to exist that way.

- One of the most beautiful things that happens when you make a film, is sharing part of you with your audience.

- She is probably one of the most insightful, empathetic people I have ever met.

And she closely observes human behavior.

And she does it in a way that doesn't disturb you.

She does it in a way that is so authentic.

- I just am really interested in what drives people.

And I want to know what it is, even if I don't find out the answer.

I wanna understand it a little better.

- (indistinct) - There were some moments filming during "Silicone Soul" that were a little uncomfortable.

- I can live without somebody to love me, but I cannot live without somebody to love, somebody to spoil and take care of and be good to.

So, I have Jackie for that.

- I really needed to find ways to balance that film from the men who have female companions with other things that made it so it was humanizing for anybody to see.

- I mean, just it's so lifelike to them, it is real.

- You have to kind of just find ways to focus on the question you're trying to answer, and that's what I do when I go out to film.

- She is able to bring out, just with a single question, to bring out a response that is so evocative and revealing.

- How many people can you say in your life that you have a daily relationship that you touch, feel, create, together every single day for 23 years... - And I still mostly work alone.

I still enjoy working alone.

It's just me, the camera and a wireless microphone.

Why do I like doing that?

It's because it creates intimacy with people and they trust me.

The really good stuff that I get in my films, I feel like comes from those rare moments when you're just with someone.

- It's not about Republicans, Democrats, it's about human nature.

- Mr. Mondale was so humble and he did not want a film made about him.

His assistant and I kind of worked in tandem and she would tell me, well, he's going to be at this event tonight, or that event tonight.

And I just started showing up again with my camera, just me and my camera, no crew, no anything.

I started following him around and you know, at one point he was like, oh, well, I guess you're making a movie about me.

- They try to argue about how I would like to see America though.

- I guess what I would want people to think about when they think of a Melody Gilbert film, is that when you're done watching it, that it creates conversations.

It doesn't necessarily give you answers.

It takes you on a journey, and it will make you want to talk after you watch it to someone else.

Hey, I just saw this.

I can't believe it.

It's something I never knew about before.

Let's talk about it.

(gentle music) - Well, that's all we have on Prairie Pulse and as always, thanks for watching.

(bright music) - Funded by the Minnesota Arts and Cultural Heritage Fund, with money from the vote of the people of Minnesota on November 4th, 2008, and by the members of Prairie Public.