The Wall Street Journal - 30.07.2019

A12| Tuesday, July 30, 2019 THE WALL STREET JOURNAL.

CONDITIONS APPLY| By Samuel A. Donaldson Across 1 Those who were elected 4 Horseshoe makers 10 Quick pokes 14 Unimpressed reaction 15 Like some discrimination 16 “He loves,” in Latin 17 • Howdy Doody, for one 19 • Toy used to walk the dog 20 Brockovich and Burnett 21 Censor’s sound 23 “___ Beso” (Paul Anka song)

24 Move, in realty lingo 25 Sushi roll topping 26 • One in hot water? 28 Levy that helped spark the French Revolution 30 Setting item 31 End for Japan or Sudan 32 Operatic soprano Fabbri 34 End for Manhattan or Brooklyn 35 What the answers to the starred clues come with 41 Salon solution

42 Collins of Genesis 43 Anaphylaxis treatment, for short 44 Walt Disney World park 47 Resident of Turkey’s capital 49 • Hilary Hahn’s instrument 51 CSI evidence 52 Loyal 53 Toronto’s prov. 54 Best Actor winner Rami 56 One of a circus walker’s pair 57 • Accessory for a Ben Franklin costume

TheWSJDailyCrossword|Edited by Mike Shenk

123 456789 10111213 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66

Previous Puzzle’s Solution

s Solve this puzzle online and discuss it atWSJ.com/Puzzles.

CAR BRA AMMAN UMA I C I C E L E S TA B I D GARBAGEDUMP IGIVE BILOXI COCOA AF I ACDC ACS GOBS AROD IMLATE CEO LORE TOLL OPART LPGA AXEL NHL SEEP I N LIFE SOLO NAE ETSY BEN TVDAD SUP I NE RECUR ASCOLDAS I CE ADA CORNEAS SPA L I N ABYSS HAT LOO

59 • Newborn’s headwear 61 Fair-hiring agcy. 62 Playing road shows 63 Co. that became part of Verizon 64 Bond’s debut film 65 “Yeah, fine” 66 Sizzling sound Down 1 Plunges into water 2 Turkey’s region 3 More piercing 4 Some cheap hotels: Abbr. 5 “Sheesh!” 6 Fridge ancestors 7 Words on a spine 8 Can’t stomach 9 February forecast 10 Crow family bird 11 Creature with pseudopods 12 Serenades, like a wolf to the moon 13 Comedian’s foil 18 Playing an extra period, for short 22 Locker room motivator

25 Span 27 “Match Game” host Baldwin 29 “God bless us every one!” speaker 33 Nuke, as leftovers 34 Rocker Turner’s 1986 autobiography 36 “Survivor” prop 37 Words of gratitude 38 Red ones are misleading 39 Shoulder decorations 40 Kitchen alcoves 44 Brought to mind 45 More tree- scented 46 Tee fabric 48 Abbr. on a business envelope 50 Home planet of Jar Jar Binks 51 Owed amounts 55 Tall and gangly 56 Feeling the workout 58 Green prefix 60 Prickly seedcase

Weather Shown are today’s noon positions of weather systems and precipitation. Temperature bands are highs for the day.

City Hi LoW Hi LoW City Hi Lo W Hi LoW

Today Tomorrow Today Tomorrow

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Anchorage 70 57 pc 66 57 c Atlanta 90 72 t 90 73 pc Austin 98 74 t 99 74 pc Baltimore 95 72 s 90 68 t Boise 97 63 pc 98 64 pc Boston 95 75 s 88 71 t Burlington 90 69 t 80 60 t Charlotte 92 67 pc 91 68 pc Chicago 77 61 pc 76 56 s Cleveland 80 68 t 79 65 s Dallas 97 78 s 97 78 pc Denver 97 63 t 95 63 pc Detroit 83 63 pc 80 59 pc Honolulu 90 78 pc 90 78 pc Houston 90 75 t 91 74 t Indianapolis 84 62 t 80 63 s Kansas City 80 62 pc 83 64 t Las Vegas 107 85 pc 93 81 t Little Rock 89 71 pc 89 69 pc Los Angeles 85 65 pc 83 64 pc Miami 92 80 t 91 80 c Milwaukee 73 62 pc 74 59 c Minneapolis 76 57 s 79 63 s Nashville 86 70 t 87 67 t New Orleans 86 75 t 89 76 t New York City 92 75 s 86 72 t Oklahoma City 95 71 s 97 73 pc

Omaha 77 63 pc 80 66 pc Orlando 91 75 t 91 75 t Philadelphia 94 74 s 89 72 t Phoenix 102 81 pc 95 84 t Pittsburgh 78 66 t 78 63 t Portland, Maine 88 69 s 83 64 t Portland, Ore. 82 60 s 85 63 s Sacramento 86 56 s 90 57 s St. Louis 84 63 s 83 63 s Salt Lake City 100 78 s 88 70 c San Francisco 70 56 pc 72 58 pc SantaFe 9162pc 9264pc Seattle 76 60 pc 79 62 pc Sioux Falls 78 61 c 81 66 pc Wash., D.C. 93 75 s 88 73 t

Amsterdam 79 60 pc 69 60 t Athens 92 75 s 91 75 s Baghdad 114 83 s 115 84 s Bangkok 92 82 t 91 79 c Beijing 95 74 pc 95 75 s Berlin 81 63 pc 79 60 c Brussels 78 58 sh 70 57 t Buenos Aires 66 50 pc 69 45 pc Dubai 107 95 pc 107 92 pc Dublin 65 53 sh 67 52 pc Edinburgh 68 58 t 66 56 t

Frankfurt 87 63 pc 78 57 pc Geneva 82 60 t 78 55 pc Havana 90 74 t 91 72 t Hong Kong 92 81 t 90 80 t Istanbul 87 73 s 90 73 s Jakarta 91 74 s 91 74 pc Jerusalem 88 65 s 90 66 s Johannesburg 73 42 s 71 41 s London 70 59 t 73 58 t Madrid 90 64 s 96 69 s Manila 87 78 sh 89 79 sh Melbourne 54 39 pc 56 44 s Mexico City 73 55 t 74 52 t Milan 92 69 s 89 70 s Moscow 59 46 pc 58 51 c Mumbai 85 81 sh 87 80 sh Paris 78 57 sh 76 58 pc Rio de Janeiro 83 69 s 81 68 s Riyadh 113 84 pc 113 83 c Rome 85 67 s 86 68 s San Juan 88 80 t 88 80 t Seoul 87 78 t 83 77 t Shanghai 99 83 t 95 82 pc Singapore 89 80 pc 90 81 pc Sydney 61 51 r 62 48 pc Taipei City 98 80 s 99 79 pc Tokyo 9079pc 9179pc Toronto 80 61 t 80 58 s Vancouver 73 56 pc 75 58 sh Warsaw 88 62 t 79 59 pc Zurich 83 58 t 75 53 pc

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s...sunny; pc... partly cloudy; c...cloudy; sh...showers; t...t’storms; r...rain; sf...snow flurries; sn...snow; i...ice Today Tomorrow

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without a uniform set of measure- ment standards. Walter Kaye, a psychiatry profes- sor and executive director of the Eating Disorders Program at the University of California, San Diego, contributed materials from earlier genetic studies to the current one. Dr. Kaye says he’s noticed how hard it is for some of his patients to gain weight. Anorexia patients might need to consume 4,000 to 5,000 calories a day to do so. The average woman needs 2,000 calories a day to maintain her weight. “That’s an enormous amount of food,” he says. He’s also published studies showing that after people recover from anorexia, they often need to eat significantly more than most people to maintain their weight. “We don’t know why these people are prone to get hypermetabolic, although it may not persist in the long term,” he says. Laura Collins Lyster-Mensh, executive director of FEAST, a non- profit advocacy group for the families of those with eating disorders, says the group helped recruit participants for the study and raised money to help fund it. “The DNA research reinforces what the families of FEAST have been saying for a long time, which is: Help us feed our kids properly and stop blaming our loved ones for choosing a disorder of vanity,” says Ms. Lyster-Mensh, whose daughter suffered from anorexia in 2002 as a 14-year-old. “They didn’t choose it.”

but they’re also fighting a funda- mental biology that doesn’t really want them to gain weight either.” Dr. Hildebrandt says he sees this with his own patients who have difficulty gaining weight and keeping it on. “Part of the reason they get stuck is, from a psychiatric stand- point, they’re anxious about eating and the effects of eating. But in addition, they have to eat a lot more. They have to work harder to eat than the average person,” he says. It’s unclear if people are born with such metabolic genes or if such genes are activated by a state of starvation. The study’s limitation, Dr. Hil- debrandt says, is that it wasn’t an independent sample. It included samples from 17 separate studies

June Alexander joined the study.

FROM TOP: ILLUSTRATION BY RUTH GWILY; MARTIN REDDY

LIFE & ARTS

SOME OF THEgenetic factors
linked to anorexia nervosa are also
associated with metabolism, sug-
gesting that there may be a biolog-
ical explanation for why patients
with the eating disorder lose
weight so rapidly and struggle to
keep weight on.
The new discovery was part of
the largest genome-wide associa-
tion study of the disease ever
done. The study, published July 15
in the journal Nature Genetics,
found eight genetic regions linked
to anorexia.
Anorexia affects up to 4% of
women and a smaller percentage
of men. It is among the deadliest
of psychiatric disorders. People
with the disease have long battled
stigmatization, getting labeled as
having a vanity condition driven
by a desire to be thin. But re-
searchers call the study the most
specific and definitive evidence
that genes and biology play a
prominent role. Though far off, re-
searchers hope the discovery will
help start the process of develop-
ing treatments that target the bi-
ology of the disease.
“Many of us have wondered for
a long time if there is more to an-
orexia nervosa than the psycholog-
ical component,” says Cynthia Bu-
lik, founding director of the UNC
Center of Excellence for Eating
Disorders in Chapel Hill, N.C., who
led the study. “These people just
override normal biology, they
override hunger signals. We’ve of-
ten wondered what it is that per-
mits them to lose so much weight

and stay down there. This might help explain why they get metabol- ically out of control.” The study analyzed the genomes of nearly 17,000 patients with the disease and compared them with 55,525 controls from 17 countries. Still, its findings are preliminary and need to be replicated, researchers say. Researchers also found people with the condition are genetically prone to high physical activity lev- els and more likely to have other conditions, including obsessive- compulsive disorder, depression, anxiety and schizophrenia.

Dr. Bulik says the goal is to col- lect 100,000 genetic samples. She expects researchers will find hun- dreds of genes associated with the disease. Only about 30% of people with anorexia nervosa fully recover. The research underscores the impor- tance of ensuring that patients get to a healthy weight to allow their metabolism to stabilize before they leave residential treatment programs. This could reduce the risk of relapse after they go home, Dr. Bulik says.

June Alexander, a 68-year-old writer in Melbourne, Australia, was among the nearly 17,000 people who contributed a blood sample for the study. Ms. Alexander was diagnosed with anorexia in her 30s after struggling with the disease start- ing at age 11. She says she wasn’t successfully treated until she was

“That was when I was able to
eat three meals every day and not
feel guilty,” she says.
The study’s findings, she says,
were a “big relief.”
“This illness makes you feel
very ashamed,” Ms. Alexander
says. “This study is saying this is
definitely an illness. I’m not
flawed. It’s the illness that makes
me feel and seem that way.”
Tom Hildebrandt, chief of the
Center of Excellence in Eating and
Weight Disorders at Mount Sinai
School of Medicine in New York,
called the research the “first step
in identifying a road map for the
neurobiology of the illness.”
That about 20% of the illness
could be derived from metabolic
genes is hugely important in re-
ducing the stigma associated with
the disease, says Dr. Hildebrandt,
who wasn’t involved with the
study.
“Anorexia is considered a self-
control problem, just eat and it
will solve the problem,” he says.
“The reality is they’re working
against their own physiology—it’s
actually much harder for them to
eat not just because of the psychi-
atric resistance to gaining weight,

A New Genetic Explanation for Anorexia

The eating disorder appears to have biological predictors that explain why gaining weight is harder for some patients

YOUR HEALTH|SUMATHI REDDY

16, Thenumberofpatientsanalyzedin theanorexianervosastudy.

The Wall Street Journal - 30.07.2019

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