Sandy Szwarc does it again

This morning I read the following sentence in Sandy Szwarc's most recent post in her Junkfood Science blog:

"Far more young people are dying from anorexia than . . . from being fat."

Tears sprang to my eyes. That is exactly right.

The emphasis on "overweight children and teens" clouds the issue for the public and for health professionals. So long as doctors and the rest of us are so terrified of being fat, and of having our children be fat, lethal eating disorders like anorexia and bulimia will be underdiagnosed, mistreated, and poorly researched.

Thank you, Sandy, for putting it so plainly.

Repeat after me: Fat is good

An interesting study crossed my desk this week, from a team of researchers in New York who posed the question, "Does percent body fat predict outcome in anorexia nervosa?"

They looked at a number of factors they thought might contribute to relapse in anorexia recovery, including BMI, leptin levels, waist-to-hip ratio, the subtype of anorexia, and percentage of body fat. Only one--body fat--seemed to affect the rate of relapse. "In recently weight-restored women with anorexia nervosa," they wrote, "lower percent body fat was associated with poor long-term outcome."

We're so used to thinking of fat as the Ultimate Evil, which must be banished at any cost, that news like this can feel downright shocking. Fat can be not just good but essential. Without it our brains don't work very well. We're supposed to have a certain amount of fat in our bodies.

This is important for those in recovery from anorexia, especially people (like my own daughter) who are naturally athletic and build a lot of muscle mass. Nothing wrong with muscles, but you've gotta have fat, too. Lean muscle mass without body fat is associated with relapse. And that's not what anybody wants.

So repeat after me: Fat is necessary for human life. Fat is not evil. Fat can even (dare I say it?) be a Very Good Thing.

Advocacy for what?

I've given a lot of thought to how those of us who have children with eating disorders can model our advocacy efforts after those of other groups. Parents of kids with autism, for instance, have been very effective in pushing for legislation covering treatments and other issues.

The thing is, most people aren't busy arguing about what causes autism in the first place, and they pretty much agree on treatments. Whereas folks in the e.d. world are divided in every possible way.

My friend Laura Collins says she'd like to lock all the e.d. experts in a room until they come to an agreement. Ha!

One of the biggest arguments, of course, is the biology-vs.-psychology one. Both parents and professionals have vested interests in taking one side or the other when it comes to both cause and treatment.

When I imagine trying to bring together a coalition of eating disorders parents and professionals to push for legislation and advocacy, I get a sense of how great the conflicts are. For instance, I don't think individual therapy is useful in treating anorexia, at least not during the active recovery phase, so I'm not sure I would want to push for legislation to cover lots and lots of individual therapy.

In case you couldn't tell, I'm of the biology camp, as in the Minnesota Starvation Study. I don't believe kids "think" their way into eating disorders, and I'm damn sure they don't think their way out of them.

I think what's needed most are more and better treatment studies, like the one Dan Le Grange is doing at University of Chicago. We need to know what the best treatments are for anorexia and bulimia.

What do you think we should be pushing for?