Join a study, help yourself and others

In the spirit of the new year, here's a list of ongoing treatment studies looking for subjects. Joining a study is one way to not only contribute to the still-infant science of eating disorders treatment, but also get excellent treatment for yourself and those you love--for free.

May 2009 be a year when eating is a pleasure and not a terror or trouble to all of you.


San Diego, CA: UCSD Researchers Seek Males and Females with Anorexia Nervosa: The UCSD researchers are currently seeking adolescents and adults currently suffering from Anorexia Nervosa to participate in one of their three current studies. To qualify for any of the studies one must be at least 15% below ideal body weight and be fearful of weight gain, despite being underweight. Both adults and adolescents between the ages of 14-45 are needed to participate in a taste study and would be compensated for up to $70 for completing the assessments, taste tests and interview. Adults 18 years of age and older are needed to participate in a randomized control trial of the medication Quetiapine, in which they will receive either the study medication or a placebo. Subjects will be compensated up to $360 for completing study related assessments and the medication treatment. In addition, they are offering several months of family therapy treatment for families with adolescents between the ages of 12 and 18 at no cost. The adolescents in this study will also be randomly assigned to receive either the medication Fluoxetine or a placebo. For more information, contact UCSD Eating Disorder Treatment and Research Program at 858-366-2525 or email edresearch@ucsd.edu.

San Diego, CA: UCSD Researchers Seek Women Recovered From an Eating Disorder: Help UCSD researchers understand what causes eating disorders. They are seeking female participants between 18 and 45 years of age who are recovered from Anorexia or Bulimia Nervosa. By participating in the study, subjects will be assisting physicians and researchers in developing new treatments for these complex and serious disorders. Subjects will be compensated for your participation in this study. For more information contact the UCSD Eating Disorder Research and Treatment Program at 858-366-2525 or email edresearch@ucsd.edu.

Maryland - Bulimia Research Study: The Johns Hopkins Eating Disorders Program is seeking women 18-40 years old with bulimia nervosa interested in a research study funded by the Klarman Family Foundation. The study includes a health assessment, blood testing and pictures of the brain taken using a medical scanner. Eligible women will be paid up to $400 for their participation and will be offered 6 weeks of outpatient treatment. Call 410-955-3863 or see this site for more information.

Massachusetts Research Study - Massachusetts General Hospital Study of Therapy for Bone Loss in Anorexia Nervosa: The Neuroendocrine Unit of Massachusetts General Hospital is conducting research studies on anorexia-induced bone loss. Their screening study is for men and women age 12-50 with anorexia nervosa. They are investigating causes of osteopenia (or bone loss) in the spine, hip, wrist and total body. The study involves one visit of approximately 3 hours. Their treatment study is for women aged 18-45 with anorexia nervosa and absent or irregular menstrual periods. They are investigating the combined use of a natural hormone and a medication that is effective for bone loss in postmenopausal women as a novel treatment for the bone loss seen in women with anorexia nervosa. They hope that the combination of these two investigational medications will help rebuild depleted bone and prevent further bone breakdown in women with anorexia nervosa. The study consists of 6 visits over 12 months. A stipend of up to $675 is awarded throughout the course of the study. If interested, call Erinne Meenaghan, NP at 617-724-7393 or email nedresearchstudies@partners.org.

Massachusetts: Bulimia Nervosa Study: Free confidential treatment is available to those who are eligible. Do you or someone you know binge eat? Do you or someone you know compensate by vomiting or other extremes? Do you or someone you know have severe moodiness or relationship problems? Researchers are now enrolling participants (ages 18-65) in a free treatment study investigating two active treatments, including education and counseling, for bulimia nervosa. If interested call 617-353-9610 or visit this site.

New York, NY: NIMH-funded, IRB-Approved Study of Adolescents with Bulimia Nervosa (ages 12 - 21 years). This study takes place at NYSPI/Columbia University and compensation is provided for participation ($100). For more information, contact Laura Berner at 212-543-5316. P.I.: Rachel Marsh, Ph.D., Assistant Professor of Clinical Psychology, Columbia University/New York State Psychiatric Institute, phone 212-543-5384, email marshr@childpsych.columbia.edu.

New York, NY: The National Institute of Mental Health is sponsoring a multi-center international study to compare two types of family therapy as well as Fluoxetine or placebo (an inactive medication) in the treatment of adolescents with Anorexia Nervosa. They are looking for families with an adolescent with Anorexia Nervosa between the ages of 12-18 years. Participation involves completing assessment interviews, questionnaires, and engaging in 16 family therapy sessions over the course of nine months with medication continuing for another six months. The study is being held at the Eating Disorders Research Program, The Westchester Division of New York-Presbyterian Hospital, Weill Medical College of Cornell University. Contact the Research Coordinator, Samantha Berthod, MA at 914-997-4395.

North Carolina: The University of North Carolina's Eating Disorders Program announces a new clinical psychotherapy trial for bulimia nervosa. This study is comparing two different ways to deliver cognitive-behavioral therapy. (CBT) which is the treatment of choice for bulimia. Patients will be randomized (like a flip of a coin) to either face to face group CBT or internet-delivered CBT with a therapist-moderated chat group. There is no cost for participating in this trial. Eligibility Requirements: Male or Female, at least 18 years old, have a home computer with Internet access. Contact the Research Coordinator at 919-966-2882 or cbt4bn@unc.edu for more information.

Happy merry to you!

I thought this study might be a fitting gift of the season to my blog readers. Because Feed Me! is about more than nutrition and eating--it's about feeing yourself spiritually and emotionally as well.

Enjoy--and happy new year!

Say What?

This poll from CBS has to be one of the weirdest things I've read in a while. It reminds me of the kind of question you'd ask at an 8th-grade sleepover: Which is worse, burning to death or freezing?

I point it out because one of the questions asks,, "What's worse, being obese or suffering from anorexia nervosa?" Take a guess how "people on the street" responded. The pollsters go on to explain that 20 percent of anorexics die from the disease, whereas a 25-year-old obese woman has only a .01 percent chance of dying.

Other questions included comparisons between smoking pot and cigarettes, between having a swimming pool and a loaded gun, and between being married and miserable or single and happy. Each time there was a "counterintuitive" answer. People were apparently surprised to learn that anorexia is deadlier than obesity, that having a swimming pool is more dangerous to your family than keeping a loaded gun, and so on.

Weird, but maybe useful.

The "obesity tax"

I thought about posting on this a few days ago, when Governor Paterson first proposed a tax on non-diet soda, and decided that other folks had tackled it ably, so no need.

Tonight, as I was listening to yet another commentator go at this issue on NPR, I thought about my friend P., who became diabetic a couple of years ago, stopped eating sugar altogether, lost 30 pounds, and nearly blinded herself cooking with Splenda. She used it in a dish she cooked on the stovetop and leaned over the pot at just the wrong moment. Splenda, it seems, contains chlorine, and apparently some of that chlorine is released during cooking. P. got a faceful of it and went temporarily blind. Luckily she got her vision back.

I thought about the long-running debate over whether aspartame (the artificial sweetener in Equal and NutraSweet) causes cancer. Well, actually, it does cause cancer in lab rats; the question is whether its carcinogenic properties extend to humans, and at what levels/doses. When I was growing up, my mother and grandmother and pretty much every grown-up woman I knew kept a little enameled or cloisonne pill holder in their purses. I used to beg my grandmother to let me use the tiny tongs that came with hers to drop sacccharine pills into her after-dinner coffee. My grandmother died of lymphoma, probably more closely related to her years of smoking than to her saccharine intake. Or was it?

I think Governor Paterson's tax has more to do with New York State's budget deficit than anything else, but I still have to wonder whether he thinks it's better to risk blindness or cancer than fatness. Remember that study where nearly 90 percent of people surveyed said they'd rather be blind than fat? I guess Governor Paterson has his finger on the public pulse after all.

New stuff at MP.org

If you haven't visited the Maudsley Parents site in a while, take a look. We've posted lots of new content, including a wonderful video interview about anorexia with Dr. Daniel le Grange of the University of Chicago, done by our own Jane Cawley. There's also new information in Spanish, a new article on eating disorders in boys, an updated and downloadable recipe collection, a video interview with Dr. le Grange on bulimia, and more. Plus there's a new search feature on the site.

Stop by and let us know what you think! Kudos to Jane Cawley for the new content and organization, and to Ann Farine, our web designer.

What I said

Nearly a year ago I wrote a post about Oprah's public battle with weight. Back then I wondered whether anyone could "win" the "battle of the bulge," if Oprah with all her money and resources couldn't.

Now the comment is a bit different: If Oprah, with all her ups and downs, her struggles to accept herself as she is, her repudiation of her body and her appetite, can't learn to love herself, then who can?

The answer: You can. I can. Even Oprah can.

But to do that, you've got to let go of the fantasy image of yourself as you wish you were.

You've got to grieve for the vision of yourself you've held dear for so long. You've got to grieve for that perfect you, the one who floats effortlessly through the world, svelte, unsinkable, emotionally airbrushed. You've got to learn to love instead what you've got: your thighs and your big heart, your dreams and your pores, all of them part of the same imperfect and vastly more interesting package than any airbrushed toothpick-thin fantasy could ever be.

Oprah, if you're reading this, I'm rooting for you--not to lose that weight again, but to gain something infinitely more precious: yourself.

Round-up time!

I've been a Very Bad Blogger recently, for which I am deeply sorry. :-) Here are a few tidbits to tide you over until I can come up with a brilliant new post.

First, 3 new studies looking for participants:

The Mount Sinai Eating and Weight Disorders Program is offering study treatment as part of a federally funded study (Principal Investigator: Katharine Loeb, PhD) for children and adolescents with symptoms of anorexia nervosa. If your child is 10-17 years old, is medically stable, and is developing signs and symptoms of an eating disorder, s/he may be eligible to participate. The study is approved by the Mount Sinai School of Medicine Institutional Board (Protocol 04-0978, approved through 8/31/09). For more information, call Lauren Alfano, 212-659-8724.

The University of Chicago is looking for adolescents with bulimia nervosa and their families for participation in a 6-month outpatient treatment research study. (Principal Investigator: Daniel le Grange, PhD) The purpose of this research study is to identify effective outpatient psychological treatments for adolescents with bulimia nervosa.
To be eligible the child must be between 12 and 18, be living with at least one parent, and have a diagnosis of bulimia nervosa or partial bulimia nervosa. Participating families will engage in 6 months of outpatient therapy for bulimia nervosa at The University of Chicago Hospitals. These treatments have the potential to bring about improvement in eating disorder symptoms. For more information, please call the bulimia nervosa treatment study at (773) 834-5677, email bulimia@yoda.bsd.uchicago.edu, or visit the Treatment of Bulimic Adolescents Study webpage.

The Johns Hopkins Eating Disorders Program is looking for women 18-40 years old with bulimia nervosa interested in a research study funded by the Klarman Family Foundation. (Principal Investigator: Angela Guarda, MD.) The study includes a health assessment, blood testing, and pictures of the brain taken using a medical scanner. Eligible women will be paid up to $400 for their participation and will be offered 6 weeks of outpatient treatment. Please call (410) 955-3863 for more information.


Next, mark another milestone in the Fight Against Good Foods/Bad Foods: Researchers in Spain have found that a handful of nuts added to your diet each day lower cholesterol and other cardiovascular risk factors. Whether this will actually decrease heart attacks and strokes is anybody's guess. The good part from my POV is that it moves nuts back out of the "bad food" category. Someday, somehow, we will abolish those categories . . . and this is a step in the right direction.

And finally, a shameless plug for my upcoming anthology, Feed Me!: The first review is in, and it's a good one, from Booklist. To see it, join the Feed Me! Facebook group--I've posted it there.

Send me your food/eating/body image news to get me through the grading of final projects. Thanks!

This is the way we legitimize fat prejudice

My local paper, the Syracuse Post-Standard, is really pretty good, especially for a small city paper. Like many small papers these days, it picks up a lot of stories from wire services. Today's post concerns one of those wire stories,which ran in the feature section as "10 simple things you can do today to improve your life."

Number 3 on the list is "Put one foot in front of the other." It's a plug for exercise, specifically for walking, which I am in favor of, and advocates getting a pedometer to measure your steps. We're all supposed to walk 10,000 steps a day. I'm good with that. But halfway through the item I came to this sentence:

Those in the obese range usually take between 4,600 and 6,000 steps a day, overweight people walk 6,000 to 7,000 steps a day, and those of normal weight tally 8,000 to 10,000 steps a day.

Where to begin: With the idea that anyone who's not overweight is "of normal weight"? (Since when is being underweight normal?) Or with the random declaration that obese people walk no more than 6,000 steps a day?

I've worn a pedometer, and I've typically taken between 7500 and 9,000 steps a day. I have to make a conscious effort to reach 10,000 steps a day, it's true, but according to this article, since my BMI is in the obese category, I should be more of a couch potato.

It's just another example of how silly these kinds of "health" stories can be. And as a member of the media myself, I really shouldn't get exercised (pun intended) about ridiculous things like this. But I do. Because every one of these stories underlines, subtly or overtly, our cultural attitudes and assumptions about fat people, and so leads to more fat prejudice and stereotyping.

And there's already plenty of that to go around.

Wanted: Snappy comebacks

It's inevitable: Whenever I see people I haven't seen for a while, one or two of them are sure to say something like "You've lost weight! You look so good!" Not because I've lost tons of weight. Maybe I've lost 5 pounds, but I really don't know (and don't care) and haven't weighed myself in months. I think it's because I'm happy. Oh, and my hair is longer.

The point is, I wish I had something to say in this situation. Yesterday an acquaintance gushed on and on about my putative weight loss, and I said, "No, I really don't think I've lost a lot of weight." Her response: "I beg to differ!"

Excuse me? You're telling me about my body? I know she meant well, but it was tres frustrating. I wish I had some snappy (but not snarky) comeback to offer in this situation.

Any suggestions?

Good Book, Bad Book

I can't wait till the latest round of kids'-books-to-combat-childhood-obesity passes. Each one seems more offensive than the last.

Today's review looks at I Get So Hungry, by adult fiction writer Bebe Moore Campbell, who died not long ago. I love Campbell's fiction--usually. But this book, like so many of its ilk, is nothing short of craptacular.

Its main character is a young girl named Nikky who is teased at school for being fat. Nikky is fat because she's a compulsive eater. She eats when she's sad, upset, angry, bored, and hungry. She eats junk food, and lots of it. When her adored and also fat teacher goes on a diet, Nikky wants to also, but her mother won't buy fruits and vegetables--not until she goes to a parent teacher conference and sees how skinny the teacher has become.

This book doesn't even pay lip service to the notion that people come in all shapes and sizes. It equates being fat with being emotionally dysfunctional and/or gluttonous. And it out and out lies: if you eat fruits and vegetables and walk every day, you'll lose lots of weight, according to the book. Oh, and come up with snappy putdowns for your tormentors.

By contrast, a wonderful book called Fat, Fat Rose Marie, by Lisa Passen, takes on the same subject matter--a little girl is teased for being fat--and handles it so much better. Rose Marie is befriended by another child who's the butt of teasing, because she has red hair and freckles, and together they empower each other and teach the other children to look beyond the surface to the person within. Rose Marie is never shown shoveling in food, as Nikky is; nor is she emotionally dysfunctional. She's just fat.

Lisa Passen's book was published nearly 18 years ago, proving once more that we're in a kind of Dark Ages when it comes to body image and weight. I can only hope we'll emerge sooner rather than later into our Renaissance.

What exactly is "moderate" exercise?

That's the question posed by a study in progress being done at the State University of New York and Syracuse University.

The Surgeon General recommends that everyone get 30 minutes a day of moderate exercise--but what, exactly, does that mean? Language is powerful but not always specific; what feels moderate to you might feel excessive to me, or maybe underwhelming.

Researcher Cameron Hall set out to explore people's perceptions of moderate exercise. I was lucky enough to be able to volunteer for the study, and it's been fun. On the first visit, I came into the lab, where they hooked me up to all kinds of monitors and meters and put me on a treadmill to measure my maximum exercise tolerance. They measured my oxygen consumption, heart rate, and perceived levels of exertion with one of those little charts where they ask you to point to how hard you think you're working. Pretty damn hard, by the end.

On the next visit, I was asked to walk around a track at what I thought was a moderate level of exercise. I booked it, let me tell you, wanting to surpass the researchers' expectations of me. I walked much faster than usual, averaging around 4 miles per hour instead of my usual 3.7. On the third visit, we were back in the lab, only now the researchers were telling me how fast and hard I had to work to hit the middle part of my range by the numbers.

It turned out that what I think of as moderate is nowhere near what the numbers say. Visit 3 was excruciating because we had to keep the treadmill flat for comparison purposes to the track we used on visit #2. I had to walk 4.2 miles an hour and even then could barely get into my moderate heart and oxygen consumption ranges. This might not have been a problem if I were, say, six feet tall. But I'm just about five one, and my legs just aren't that long.

So I learned what I personally have to do to get in the recommended half hour of "moderate exercise": Set that treadmill at 3.8 and crank up the incline to between 3 and 5 percent. I did it yesterday, and let me tell you, I was working hard. And that's what the researchers think will be the upshot of the study: You probably can't protect your cardiovascular health by strolling around the block with the dog or taking a leisurely stroll. You've gotta book it, baby.

What I love about this study is that it acknowledges both the power and pitfalls of language. Words are imperfect vehicles for expressing what we feel and what we know. But they're all we've got. Sometimes our task is to learn to use them more expressively. Sometimes, as in this case, our task is to connect them to cold hard facts.

The study results should be published within the next few months. I'll keep you posted.

Feed Your Head

It's official: You can pre-order my new anthology, FEED ME: WRITERS DISH ABOUT FOOD, EATING, WEIGHT, AND BODY IMAGE at Amazon. Yay!

I'm excited about this collection, if I do say so myself. There are some tremendous essays in here, from writers like Amity Gaige, the ever-hilarious Laurie Notaro, Caroline Leavitt, Ann Hood, Joyce Maynard . . . and, yes, yours truly. And they cover just about every aspect of our relationship with food. Plus the collection got awesome advance praise from Mary Pipher (one of my favorite writers), Betsy Lerner, Ellyn Satter (another one of my faves), and Nancy Redd.

Random House is producing a digital excerpt, with the introduction plus three essays. I'll load it onto the blog when it arrives.

Stay tuned. . . .

Support group meeting in Madison, Wisconsin

The Madison parents' support group is meeting tomorrow, November 11th. This group is for any parents interested in using family-based treatment (the Maudsley approach) for their child with anorexia or bulimia. Parents who aren't currently using it but who would like to know more are welcome to attend. This is a great and inspiring group of parents.

Where: Starbucks on University Avenue, Madison
When: 7 p.m.

No need to RSVP. If you want more information, please contact Denise Reimer at remier1@charter.net.

One result of the hype around "the obesity epidemic"

Thanks to fellow blogger Carrie Arnold over at Ed-Bites for picking up on this study out of Australia, which points out an alarming rise in both obesity and disordered eating--together, in the same people.

As Carrie and some of the commenters on her blog point out, many doctors would applaud weight loss in someone considered obese, no matter how s/he achieves it. As the study's authors write:

In recent years, the obesity ‘‘epidemic’’ has received much attention in the media and from politicians, public health promotion, clinical health professionals, and others treating obesity. Perhaps these confronting, and at times alarmist, messages, have been conducive to increased levels of body dissatisfaction among obese individuals, and to a perception that weight loss at any cost is the best outcome. This might also account for the observed increase in the prevalence of binge eating and extreme weight control behaviors, as body image dissatisfaction is a risk factor for disordered eating.

Weight loss at any price—that sums it up nicely. And when diets fail (as they nearly always do), some people turn, out of desperation, to restricting, purging, and other unhealthy behaviors. Teenagers are especially vulnerable, I think, because they get a heavy dose of judgment from both peers and doctors.

So if you're a pediatrician, I hope you'll take a closer look at this study and think about its implications. If you know a pediatrician, I hope you'll forward the study on. I think our best hope for change around this issue is not creating these attitudes in the first place.

Eat well. Exercise because it feels good. And love your body for its power, its strength, its beauty, and its sturdiness.

Blame it on the sertraline?

This story from the U.K. links sertraline--the generic name for the antidepressant Zoloft--to a young woman's death from anorexia.

"One of the side effects is the reduction of appetite," said the psychologist who treated the young woman.

What will it take to make people understand that anorexia is not the result of reduced appetite? That it's a brain disorder with genetic and biological underpinnings?

Many people (including myself) take sertraline without becoming anorexic.

Just once, I'd like to see a news story that showed a true understanding of anorexia. Just once.

Need a laugh?

Things have been a bit slow on the blog lately. Sorry about that--being a first-time professor takes up a lot of time, as it turns out! This post, The OCD Diet, should make up for that. Don't read this at work, unless you don't mind falling on the floor laughing hysterically in front of your colleagues.

We STILL don't get it

I was saddened to read today of a woman in York, England, who died of complications from anorexia. Carole Patrick had struggled with anorexia for 30 years, according to this article. Chronic malnutrition led to osteoporosis, which led to a fall that broke her hip and made it impossible for her to recover when complications developed.

But I was shocked to read this line, buried in the article:

York Coroner Donald Coverdale, recording a verdict of death by misadventure, said her death was the “unfortunate and unintended consequence of a medical condition arguably under her control."

You would think medical people, at least, would understand that anorexia is not a choice. Anyone who's ever watched someone they love suffer with an eating disorder understands this basic fact; why can't the medical profession get it?

A few paragraphs down, a spokeswoman for BEAT, a UK-based organization supporting people with eating disorders, had this to say about anorexia:

. . . disorders such as anorexia were not a “diet gone wrong” or a fad or a fashion. “They are a way of coping with difficult thoughts, emotions or experiences,” she said.

In some ways, this shocked me even more. This is the old psychodynamic perspective on eating disorders, one that has been in vogue for 50+ years. Only thing is, there's absolutely no evidence that it's true.

The latest research points to genetics and heritability as primary factors in eating disorders. EDs run in families. They're associated with clinical levels of anxiety. Many people have difficult thoughts, emotions, and experiences; very few of them develop eating disorders.

I don't expect most people to understand anorexia; we have a lot of educating to do. But I do expect medical people and organizations like BEAT to know better--or to stop speaking for all those with eating disorders.

Of parents, health, and eating

This semester I teach mainly seniors, and today I was asked by some folks in another part of the university to administer a health survey to my classes, to gauge the effectiveness of some "healthy living" efforts they've been working on for the last few years. I couldn't help noticing, as I collected the surveys, one line in particular. It was one of a series of questions about where these 22-year-olds get their health information. There were many choices (the internet, magazines, newspapers, classes, health initiatives on campus, etc.), and many of the students indicated that they didn't get health info from very many sources. The one source that almost unfailingly scored high: their parents.

That's right. Their parents. These young women (and a few men) have been living away from home for the last four years. They've been independent. They've traveled to Europe, many of them; they're close to starting their own adult lives. And yet they trust their parents more than almost any other source of health information.

I must admit that tears came to my eyes as I looked at survey after survey (just that one line, honest!).

This was especially moving and poignant given what I'd been reading earlier in the day: A book called Psychosomatic Families by Salvatore Minuchin, one of the founders of family systems therapy. Minuchin's work with families is often cited as one of the inspirations for family-based treatment of anorexia and bulimia. Until Minuchin's work, patients were routinely separated from their parents and treated (usually ineffectively) individually. Minuchin was one of the first to see patients as part of a bigger family system.

Unfortunately, his view of families was anything but positive. The title says it all: Instead of psychosomatic patients, he believed in psychosomatic families--families that through enmeshment, conflict avoidance, triangulation, and other unlovely psychodynamics created children who expressed their emotions through illness. Interestingly, Minuchin writes that he developed the idea of psychosomatic families after treating diabetic children who managed their blood sugar fine in the hospital but who had crisis after crisis when they were at home. His theory was that emotional stress at home was affecting the kids' blood sugar levels.

It's an interesting theory, and I think there's some merit in it, but not for the reasons Minuchin believed. As this rather technical article discusses, stress early in life can lead to permanent changes in physiology--in this case, rats' guts became more permeable, leading to more gastrointestinal symptoms. The idea is that some of us (rats or humans) may be more genetically predisposed to such stress mediation than others. Genes load the gun, environment pull the trigger.

For Minuchin, though, it was all environment. He blames parents for pretty much everything. For those of us who have parented children with eating disorders, his book is painful reading. For instance, Minuchin describes a family at the table with their anorexic daughter. Each parent tries to cajole, threaten, and inspire the child to eat. The child does not eat. Minuchin deconstructs the parents' behaviors as "enmeshment."

He was way off base on that one. By the time a child is in that kind of trouble with anorexia, of course parents are going to be trying to get her to eat. And of course they're going to be unsuccessful, unless they're empowered or supported by the treatment and/or professionals. Sitting in a room with a one-way mirror, pleading with their child to eat, most parents will look enmeshed and ineffectual.

Which is why I was so moved to see those answers on the surveys today. One of the fundamental principles of the Maudsley approach is that families love their children and are best positioned to support and help them through one of the most devastating experiences of their lives. Critics of Maudsley say the treatment fosters an inappropriate "enmeshment" (that word again) between parents and children. Proponents say Maudsley leverages the asset that already exists: the strong and loving relationship between parent and child.

Not all families are healthy. Not all families are functional. Not all parents love their children. But most do. And if those surveys are correct, for many adolescents and young people, parents are still an important part of the picture. And not in the way Minuchin imagined.

Update: Rogers Hospital

I got an email from the family whose daughter was being held hostage at Rogers: Their daughter came home last night. Against medical advice, but she's home.

Sounds like Rogers was still trying to bring the county in, right up to the last minute, but the family had done their homework and was able to challenge Rogers' assertions.

Now, of course, comes the truly hard part: re-feeding a 13-year-old with anorexia. But this is a wonderful example of how families that are empowered can accomplish near miracles--especially when they're motivated by love of their children.

To the family: You are awesome. As hard as re-feeding is, I found it infinitely preferable to be doing it myself, at home, rather than be far away, feeling helpless about whether my daughter lived or died. We're all rooting for you.

America the Beautiful

Anyone out there see this movie yet? I'd love to hear a report from someone who's actually had a chance to watch it. It hasn't come to Syracuse yet as far as I know. The trailer, which you can watch online, looks great.

Beacon Street Girls: books to help teens lose weight

I'd love to see readers of this blog weigh in on this post by the usually savvy Tara Parker Pope in her Well blog at the New York Times. From the comments on the blog so far, most readers just ain't getting it. You can help. :-)

Why I don't recommend Rogers Memorial Hospital: Part II

Last year I wrote about the cognitive dissonance between the marketing materials produced by Rogers Memorial Hospital, in Oconomowoc, Wisconsin, and its actual therapeutic programs and practices.

That post produced a letter from Rogers' CEO himself, complaining about my "airing my grievances in a public forum" rather than talking directly to him about them.

Dude, that's what blogging's all about. Besides, I can imagine how open he would have been to my criticisms. Yeah, right.

This time around, I'm not just writing about presentation. I'm writing about practice, therapeutic practice as it's being executed at Rogers. And it stinks.

It seems that Rogers has changed its practices around the use of feeding tubes for anorexic patients. In the past, feeding tubes were considered something of a measure of last resort, sometimes necessary to save a life but something to be avoided when possible.

Not anymore. And not only that: feeding tubes are being used to keep patients at Rogers when parents want to bring them home.

Case in point: A family whom I'll call the Smiths, whose young adolescent daughter was admitted to Rogers a few weeks ago. The family was told the girl must have a tube, and although they weren't in favor, the tube was administered. Fast forward 10 days or so. Rogers is telling the family the girl has made "little progress" and urgently needs admitting to its 30-day residential program. Family can get no information on why so little progress has been made, even with the tube. Family has been researching, and has decided they want to use family-based treatment, the Maudsley approach, to help their daughter. Family tells Rogers of their intentions and asks when daughter may be safely transported home.

Next thing family knows, their local county department of child protection services is threatening to remove their daughter from their custody if they take her home. Rogers continues to insist that daughter cannot be moved so long as she's on the tube. Family says most girls with their daughter are also on feeding tubes, which constitutes a large shift in treatment protocols at Rogers.

The girl is eating. She's terrified. She wants to go home. Her family wants to bring her home for FBT. Rogers, which claims that it incorporates some FBT in its therapeutic protocols, is playing dumb and insisting that FBT would constitute child abuse and that the girl cannot safely be sent home.

The therapists at Rogers are (or should be) familiar with the studies on FBT, which show that it is very successful for adolescents under 18 who have been sick for less than three years. (It's been successful for others, too, but there are no studies yet on those populations.)

Their actions in this case and others are deeply disingenuous. Feeding tubes are a necessary evil at times. But families should be the first line of treatment and support for adolescents--especially when the family is committed to the task of helping their child recover.

Shame on Rogers.

Why I don't fast on Yom Kippur

Millions of Jews around the world are fasting today, in observance of Yom Kippur. From sundown last night to sundown this evening, they will drink and eat nothing, in honor of the most sacred day of the Jewish calendar: the day your fate is sealed in the book of life for the coming year.

I am not fasting this year, or next year, or any other year. Not because I'm too gluttonous to give up food and drink for 24 hours. Not because I think it's irrelevant.

I'm not fasting because of what it means to be to be hungry, to be fed, and to be strong.

Let me tell you a story: My first Yom Kippur fast happened the year I turned 13--an adult for the purposes of Jewish law. I wanted to fast. I wanted to behave like an adult. I wanted to look pale and weak, to feel my stomach cave in toward my spine, to do my duty and sacrifice for the sake of holiness.

(If this sounds like the rhetoric of anorexia, well, keep reading.)

I made it through the night, the next morning, the next afternoon. Through hours of services, singing, breast-beating, and sermons. I was strong. I was proud. I was adult.

I was also very, very hungry.

In our house then, food was a kind of emotional currency. Food could be love or punishment; withholding of food could constitute either extreme. My mother was always dieting, which means that we ate, but always with the sense that we weren't really supposed to. The less you ate the better. Appetite was a bodily function that made you weak, and gluttonous, and fat. Appetite was to be squelched at every opportunity.

By 5 o'clock that Yom Kippur afternoon, I felt like I would faint if I didn't eat something. Anything. I left services and went around back, to the synagogue's playground (it was also an elementary school). I sat on the swing, went down the slide in my fancy new dress, and dug idly in the sandbox.

And that's where I found it: a half-eaten Milky Way bar. Someone had taken a few bites and then tossed it, wrapper and all, into the sandbox. It was food. It was my favorite candy bar. It was covered in sand and looked better than any food ever had to me.

I peeled the wrapper and took a bite of the uneaten side. I took another, and another, and soon had eaten the whole thing, sand and all. I felt guilty and ashamed. I was weak. I was unworthy.

I was also, later that night, sick as a dog, throwing up the candy bar and the break-the-fast meal we ate a few hours later. Retching and miserable, I had plenty of time to connect the dots: I had sinned, and I was being punished. Violently. Virulently. Righteously.

Fast-forward 35 years or so, to a night when my daughter Kitty was lying in the ICU, dying from anorexia. She was dying because she would not, could not eat. It took every ounce of determination and grief my husband and I had to help her start down the road to recovery.

That's when I connected the new set of dots: Not eating could kill you. Being hungry held no virtue. In the ultimate appetite sweepstakes, being hungry was the booby prize. You thought it was the goal, but really it was the punishment.

There have been plenty of times in my life since that Yom Kippur long ago when I have been hungry. But in the intervening years I've learned to honor my appetites--for food, for love, for compassion, for connection. This learning has changed my life.

And that's why I'll never again deliberately starve myself, for a day or for a month. There's far more virtue in learning to live with appetite and hunger than in shutting it down.

"You look great! Have you lost weight?"

I went "home" for the weekend last week--back to Madison, where I lived for 16 years. It was great to see old friends, neighbors, acquaintances, etc., and very emotional, too. It takes time, lots of time, to forge friendships. This year is rather a lonely year in Syracuse.

It was great to see those friends, but I really wish so many of them hadn't commented on my weight. The consensus seemed to be that I was looking better than usual so I must have lost weight. This conflation really, really bugs me. Why is a weight loss always associated with looking good?

I went to the doctor today and got on the scale for the first time in probably 6 months. Yes, I have lost a couple of pounds, but not, as one friend suggested, "a ton of weight!" For someone my size--five foot one and a little, 161 pounds--a couple of pounds makes little visible difference.

"You look good because you're happy," my husband pointed out. That's right. I'm engaged and invigorated by my new work and by the challenges and curiosities of making a home in a new place, and it shows.

I look forward to a day when looking good and losing weight are two separate and distinct ideas. And when we think twice before mentioning them in the same breath.

Celebrity weight watchers

I won't be the first person to rant about the intense media attention we pay to celebrities' weights, and I won't be the last. But this little video really bugged me almost as much as the scene in the Sex and the City movie where Samantha (Kim Cattrall) has gained 10 pounds, and the rest of the characters act like she should put on a burqa and have her jaws wired shut.

In this case, the video suggests that actress Demi Moore has gained 15 pounds. "Is there more of Demi to love?" croons the voiceover. The tone of voice makes it clear that this would not be a good thing.

I pity any woman (or man, for that matter) who is subjected to this kind of scrutiny. It feels to me like a form of externalized self-loathing--things we wouldn't dream of saying to or about an ordinary person may be said about a celeb because, hey, she's fair game.

We learn, from the culture that produces such relentless trash, to say these things to ourselves, about ourselves. Videos like this feed the nasty little voice that lives in our heads, telling us you're fat, you're ugly, you're old, you're worthless. For some of us, this voice can become deafening. For some, it stays relatively quiet.

But you know what? Even a whisper of this is too much.

Harvard bucks the mainstream on "nutrition information"

Last year, if you ate at a Harvard dining hall, you were confronted by a large sign listing the calorie, fat, protein, etc. content of everything you ate.

This year the signs are gone, thanks to a group of parents who protested them.

"The feeling was that for people who have eating disorders or who struggle with issues around the literal value of food, the emphasis on nutrition information does not always lead people to eat in a healthy manner," said Harvard dining hall spokeswoman Crista Martin.

It's naive of anyone to think that an "emphasis on nutrition information" will lead to "healthier" eating decisions. Most of us can't help but be aware of fat grams, calories, etc. in the food we eat (or don't eat), and the effect is hardly salutory.

I practice intuitive eating most of the time. I gave up dieting years ago. I parented a child through anorexia. But when I'm faced with those "nutrition information" signs, I immediately feel that whatever I'm eating, or about to eat, is too much. I immediately slip back into a mindset of any calories are too many.

It's like the story about the old miser and his horse. Each day the miser fed his horse a little less, until finally the horse died of starvation. The miser's comment: "Just when I was training him to need no food at all!"

Those calorie count listings make me feel as though the goal is to eat as little as possible--ideally, nothing. They immediately trigger fear, anxiety, and the restricting mindset.

Luckily I am too ornery to stay in that mindset for long. But is it really a surprise that for students at Harvard, one of the most competitive schools on the planet, signs listing calorie counts of everything served in the dining halls might be a bad idea? That a vulnerable population (driven, intensely competitive Harvard students) might be triggered by these reminders of "healthy eating"?

I don't think so.

I only wish the rest of the world would follow Harvard's lead on this one.

Free bulimia treatment

A research team at University of North Carolina, led by the fabulous Cindy Bulik, is looking for people with bulimia to take part in a pioneering study on treating this disease.

The study takes place at two sites: UNC, in Chapel Hill, and University of Pittsburgh. But you may not have to live in either of those places to enroll in the study, because half the study participants will be randomized to what researchers are calling CBT4BN, a web-based treatment involving weekly on-line chats with therapists and other distance elements.

The idea is to get treatment to people who may not have access to a therapist trained in cognitive behavioral therapy (CBT), which is currently the gold standard of treatment for adults with bulimia. The Maudsley approach has shown great promise for adolescents with bulimia.

Eating disorders are terrible, life-sucking diseases, and their treatment is still largely mysterious. Studies like this one are literally a lifeline to people struggling with EDs. So thank you Cindy, and the rest of the team, for doing this crucial work. Those of us who have seen people we love come suffer with an ED are very grateful.

Fighting weight discrimination, one doctor at a time

If you've ever had the experience of going to a doctor for an earache and being lectured on your weight--or even if you haven't had that experience but dread it--there's hope for America's doctors. Yale University's Rudd Center has created an online course to help sensitize docs to weight discrimination in themselves and in the health-care system. According to a spokesperson, the course is also designed to help docs develop strategies to serve their patients better--always a good thing.

Doctors get 1 credit of continuing ed for doing the course, and their patients get a doctor who's at least been exposed to the notion of fat acceptance and questioning the status quo on weight.

I looked at the first few frames of the course and have to say it looks pretty cool. Check it out. Better yet, get your doctor to check it out.

Fighting Stigma with Science

This video is required watching for anyone with an interest in eating disorders. Cynthia Bulik is one of the leading researchers in the field, and this interview, done by Jane Cawley, co-chair of Maudsley Parents, is compelling and important. Take a look.


Fighting Stigma with Science from Jane Cawley on Vimeo.

Eat to enjoy, not to lose weight

This article in the New York Times may seem a bit redundant to some, but I'm encouraged to see it in the venerable Gray Lady herself. It saddens me a bit that the notion of eating for pleasure rather than weight loss is such a novelty, but there it is. At least it's out there.

David Foster Wallace, 1962-2008

My closest encounter with the writer David Foster Wallace, who committed suicide last week, came when I was working as an assistant in a small literary agency. One of my jobs was to read the slush pile, the manuscripts sent in cold by hopeful writers looking for an an agent. One of the manuscripts that came across my desk was a draft of what later became Wallace's first published book, The Broom of the System. It was brilliant, entertaining, dazzling, and I wanted to take Wallace on as a client. My boss said no. "He'll never be a commercial writer," he said scornfully, and that was that.

He was wrong, of course, about that and many other things. Wallace went on to become not only critically acclaimed but to achieve some measure of commercial success. He was an original, one-of-a-kind, a writer of immense talent and heart. From the oustide, his life looked golden in every way.

He was also, we know now, severely depressed for much of his life. His struggle with depression came to an end last week when he committed suicide. And therein lies my point. It is impossible to know, from the outside, what anyone else's interior life is really like. That works both ways: The perfect-looking life may be a living hell, and the seemingly diminished life may be rich and full in ways outsiders can't imagine.

I bring this up not only because I'm mourning a writer of grace and heart; I bring it up in this blog because eating disorders, like depression, often present a golden exterior. The life of someone with an ED can look wonderful, perfect, fulfilling to an observer. Yet the person who struggles, every day, every minute, with anorexia or bulimia or ED-NOS, may be smiling through torment.

When I read about Wallace's death, I couldn't help thinking about how many people with anorexia wind up committing suicide as well. And I mourn them too--the lives that could have, should have gone a different way.

I mourn the misfire of chemicals in the brain that causes severe depression, anxiety, eating disorders. And I look forward to the day when we will know more and be able to help more.

In the meantime, go out and read one of Wallace's works, and remember this talented and tormented man.

No evidence-based treatment for anorexia?

According to this study, which is an overview of 40 years of eating disorders treatments, there are still no evidence-based treatments for anorexia nervosa. "A specific form of family therapy (based on the Maudsley model) appears promising," write the study's authors.

Appears promising? Actually, FBT, or the Maudsley approach, has been shown to be successful (85 to 90 percent long-term recovery rates) for treating both anorexia and bulimia. In the last 10 years there have been several good studies on FBT, including this one, this one, and this one.

And yet some of the top researchers in the field are still saying that there is no evidence-based treatment for anorexia, and that the Maudsley approach "appears promising." Which is rather like saying that there appears to be a link between smoking and lung cancer.

After 40 years with no other good treatments, you'd think researchers would jump on this one. So why the damning with faint praise?

Come on, you guys. You're the ones who can get the word out to parents best. You have a moral obligation to spread the word about FBT--the ONLY evidence-based treatment we've got at the moment for treating anorexia. I'll be thrilled if we turn up more treatments that are effective. In the meantime, though, let's use what we've got.

Take a survey, help eating-related research

The invitation below comes from a graduate student at the University of Maryland. Please correspond directly with her if you have questions. Take the survey and help add to what we know about eating.

--HB

TO ALL WHO WROTE IN: The link has been fixed now. Thanks for letting me know!

TAKE A SURVEY

Do you love food? Can you often “out-eat” most of your friends? If the answer to either of these questions is “yes,” you may be a great candidate to take my survey.

My name is Colleen Schreyer, and I am a grad student at the University of Maryland, Baltimore County. I am doing my master’s thesis on individuals who are able to eat a lot of food, and genuinely enjoy eating. I am also looking at individuals who are able to eat a lot of food, and perhaps don’t feel so good about it. I have an online survey that takes approximately 30 minutes to complete. All participants are entered in a drawing to win an Apple Ipod. Your answers are completely confidential, and I have approval from my university to conduct this research. If you would be willing to check out the survey, please click on thIS link. All and any help is greatly appreciated. If you have any questions, please email me- colleen2@umbc.edu. Thanks so much for your time!

An open letter to all diet food peddlers

Due to the recent avalanche of PR-type emails to my inbox, I feel compelled to write this letter.

If you do PR for a diet-related product, please do not send me emails offering to send me samples and hoping I'll review it on my blog.

Don't send me perky emails about 100-calorie foods that will fill you up all day, packed full of unparalleled nutrients. (Really! Who dreams this crap up?) Don't think I'll shill for you. I won't. If I write about your diet product, rest assured I will tear it apart. That kind of publicity you really don't want.

This blog is NOT diet friendly. To paraphrase my late friend Mimi Orner, we are anti-diet, anti-anorexia, anti-bulimia, anti-healthy eating fascism, and anti-eating disorder here. I am not your friend. My readers are not your potential customers.

This blog is a diet-free zone. Go peddle your crap somewhere else.

Support group for parents: Madison, Wisconsin

The next meeting of the Madison, Wisconsin, parent support group will take place on Tuesday, Sept. 23, at 7:30 p.m. at Starbucks, 3515 University Avenue. This group is parent run and offers support, practical advice, encouragement, and hope for parents whose children are struggling with eating disorders, with a special emphasis on Family-Based Treatment (also known as the Maudsley approach).

For more information, contact Denise Reimer, reimer1@charter.net.

And if you'd like me to post a parent support group in your area, please email me off the blog at hnbrown at tee dee ess dot net.

Naturally fat?

This comment, made in response to an earlier post, seems to epitomize so much of the anti-obesity attitude that I thought it deserved its own post:

Of course there's nothing wrong with being fat. I don't get why fat people get offended when we say that obesity is dangerous. We're not talking about people who are fat. We're talking about people who are dangerously obese. You remind me of the naturally skinny girls who get offended when people speak out against anorexia nervosa and complain, "Why does everyone hate skinny people? Wah!"

There is absolutely nothing wrong with being naturally fat or naturally skinny. But if someone is deathly thin or morbidly obese then it is a real problem.

So first of all, please tell us how to distinguish between "naturally fat" and "morbidly obese." What is "naturally fat"? Is it the-amount-of-fat-I would-have-had-if-I'd-never-gone-on-a-diet? Is it 5 pounds "overweight"? 20? 50? Is it the same for you as it is for me? Is it fat that comes from eating avocados and almonds as opposed to chocolate cake and ice cream? Who decides what constitutes natural fat vs. unnatural fat?

I'm fascinated by the semantics around this issue. Morbidly obese = morbidity = a death sentence if you're fat. When's the last time you heard anyone called "morbidly skinny"? And yet semi-starvation can certainly kill you.

Personally I don't know any "naturally skinny girls who get offended when people speak out against anorexia nervosa." Someone who is thin but not eating disordered typically wouldn't be offended by this. Someone who's eating disordered, either diagnosed or subclinically, might well be offended because the nature of anorexia is to be ego-syntonic. They identify the illness with themselves and will defend it to the death--their own. They can't help it; it's a symptom of the disease.

I hope my readers will weigh in (so to speak) on this one. I'd like to know what you think.

Fat-free picnic

My younger daughter and I just came from an all-school picnic at her new school. She's starting 8th grade on Monday. The picnic was massive--800 people milling around the school grounds on a humid, muggy night. It wasn't the kind of event where you meet and really get to talk to people, and that was OK.

What wasn't OK was the food. Oh, it tasted all right, but I noticed there was nary a speck of fat or sugar at the picnic. There were flame-grilled veggie burgers, grilled chicken breasts, and I believe some kind of hot dog (I don't eat meat, so I didn't notice). There was pasta salad in a vinaigrette that was all vinegar. There were grilled veggies, which were very tasty. There was a huge bowl of salad with an array of dressings, every one of which was fat-free. I asked one of the caterers if there was any salad dressing with oil in it, and she said, "Honey, they specifically told us to bring only fat-free dressings."

For dessert there were trays of watermelon, which happens to be the one fruit I dislike.

I just hope this isn't a sign of things to come.

Are you a woman in your 20s or 30s? Read this

This opinion piece is not on the topic of food or eating, but this is a crucial and compelling subject, and one that every woman (and man) in America today should read. Especially those of you who think feminism was what your parents and grandparents did, and you're the new post-feminist generation. :-) There is still work to be done, my friends.

Suffer the little children

The latest "SmartSummary" from our much-hated health insurer arrived in the mail yesterday. I'm sure one reason our premiums are so high is that they periodically generate an 8-page booklet for each member of the family, replete with all sorts of useless information.

The piece that really burned my boat was this page, which arrived only with my 8th-grader's package. Let's take a minute to deconstruct this noxious document, shall we?

First, take note of the underlying threatening tone of the introduction. In case you can't read the scan, here it is:

Before you go back to school, take a minute to think about how sitting in class means you'll need more time for physical activity outside of school to stay healthy. Use this Body Mass Index (BMI) to figure out if you're in a healthy weight range, then you can see how to burn more calories and eat healthier in a way that fits your lifestyle.

Ths little gem offends on a variety of criteria, starting with the grammatical and syntactical errors (comma splice, word repetition, and excess verbiage). It then moves on to emotinal blackmail. Sitting in class leads to not staying healthy, unless you add more physical activity. There's a not-so-implicit threat here: You've got to burn off every minute you spend sitting on your tush and studying, kids.

For a kid like my older daughter, who likes to play by the rules and do everything "right," this notion could be enough to trigger a lifelong eating disorder, not to mention a fear of school and studying. And who's to say that each kid isn't already plenty physically active? The summary assumes that kids aren't getting enough exercise. Maybe they are, maybe they aren't. But this piece of paper sure as hell doesn't know.

Moving down the page, notice the list titled "Burn the Calories." One of the most egregious ideas behind the whole "wellness" movement is the idea that you can quantify and generalize in this way. Whereas anyone with a whiff of education on the subject knows that this depends not only on the size and age of the person in question but on his/her particular metabolism. Yet this paper confidently announces that a half hour of soccer burns 238 calories. Bullshit.

The eating disorder triggers continue on the bottom left of the page, where my daughter is told that 1 small cheeseburger would take 29 minutes of jogging to "burn off." There's a lot wrong here, starting with the idea that every bite you take must be "burned off." That's like saying every gallon gas you put into your car must be used immediately. Then there's the implicit idea that the foods listed here--plain "donut" (sic), cheeseburger, piece of pie, fried chicken sandwich--are bad for you and must be routed from your system asap.

Finally there's the ubiquitous BMI calculator and BMI chart. Once more with feeling: The idea of "ranges" is beside the point, especially for growing children. What's healthy for one child at one point in her life will not be the same as what's healthy for another child, or for the same child six months later.

I call this Bullshit 101. And I'm ever so glad my hard-earned money will no longer be going toward creating such appalling crap.

Off-topic: Need a laugh?

These came to me from my dear husband, who got them another blog, and I just couldn't resist.

Here are the top nine comments made by NBC sports commentators so far during the Summer Olympics that they would like to take back:

1. Weightlifting commentator: 'This is Gregorieva from Bulgaria. I saw her snatch this morning during her warm up and it was amazing.'
2. Dressage commentator: 'This is really a lovely horse and I speak from personal experience since I once mounted her mother.'
3. Paul Hamm, gymnast: 'I owe a lot to my parents, especially my mother and father.'
4. Boxing analyst: 'Sure there have been injuries, and even some deaths in boxing, but none of them really that serious.'
5. Softball announcer: 'If history repeats itself, I should think we can expect the same thing again.'
6. Basketball analyst: 'He dribbles a lot and the opposition doesn't like it. In fact you can see it all over their faces.'
7. At the rowing medal ceremony: 'Ah, isn't that nice, the wife of the IOC president is hugging the cox of the British crew.'
8. Soccer commentator: 'Julian Dicks is everywhere. It's like they've got eleven Dicks on the field.'
9. Tennis commentator: 'One of the reasons Andy is playing so well is that, before the final round, his wife takes out his balls and kisses them... Oh my God, what have I just said?'

It stands to reason

that if your knees have deteriorated enough to limit your mobility, you are less able to exercise. But that little piece of common sense hasn't stopped the British health care system, which refuses knee replacements to Britons who are considered "clinically obese"--with BMIs of over 30.

Now a study from the University of Southampton demonstrates that yes, Virginia, fat people benefit from knee replacements, too.

Just for a little context: My BMI is 30.9. I am a physically active person who bikes or walks to work (3 miles), runs up stairs, bikes 8 or 10 miles for fun, and loves to go dancing. If I needed a new knee, I would be one pissed-off person if I was told I was too fat to get one.

For once, common sense may prevail. Though let's see if the NHS changes its policies before we celebrate.

Join the fray . . .

over at BusinessWeek, where there's a somewhat spurious debate going on over whether the media causes eating disorders. Normally I try to stay away from arguments like this, but because it's BusinessWeek, a fairly respectable publication, I think it's worth it to put the point across. Be warned: There are some real trolls commenting over there, so don't visit if you're feeling fragile.

We're getting there. . . .

And I know this from reading pieces like this in the New York Times. Turns out your performance on a treadmill test is a far better measure of your mortality risks than the numbers on a scale. We told you so!

So yes, it's better to be fat and fit than skinny and unfit. And yes, let's take a look at just how loaded words like fat and overweight are in our culture.

I can't wait for this kind of thinking to percolate down through the culture. Just last night I was at dinner with, among others, a woman who teaches others about exercise and fitness. She paid lip service to some of the "fat but fit" thinking, but her parting comment was so typical of this debate: "But it's still bad to be fat."

I'm sending her the link to this article. Hope she gets it.

Book review: Why She Feels Fat

If you pick up Why She Feels Fat, by Johanna Marie McShane and Tony Paulson, because you want to understand the inner life of someone with anorexia, bulimia, or binge eating disorder, you'll be sadly disappointed. Actually I think you'll be disappointed no matter why you pick it up. There are dozens of books exactly like this already in print. The world certainly doesn’t need another one.

I expected to read an insightful exploration into the biology and psychology of eating disorders. I expected to find an answer to the question posed by the title. Why do people with anorexia and bulimia feel fat even when they’re not? The phenomenon has been well documented; Walt Kaye tells the story of bringing two 70-pound anorexic women into a class of med students and asking them to describe each other. Each sees the other as way too thin, gaunt and unattractive. Each sees herself as way too fat. This is a fascinating demonstration of distorted brain chemistry at work.

But these aren’t the kinds of questions the authors take on. Their answers to the question posed in the title are the same old same old we’ve been hearing for many years now about eating disorders: She feels fat because she was sexually abused, because her parents divorced, because her mother is overly critical and her father is absent. She starves, binges, and/or purges because—wait for this groundbreaking revelation—it’s a way to control a disappointing or painful world.

There's nothing about biology, genetics, or any of the new research on eating disorders that is changing the way we understand and treat them.

There's nothing new about the so-called insights offered by this book: They're all the rationalizations and delusions of eating disorders, offered up without analysis or true understanding. When my daughter was ill with anorexia, I heard them all. The difference is that I didn't take them at face value. These authors appear to do just that.

The section on treatment is just as outdated and even harmful. "The job of the therapist is to help your loved one understand, acknowledge, and resolve the issues that are fueling her illness," write the authors. In the meantime, if your loved one starves to death, or has a heart attack, well, never mind. At least they'll get to the bottom of the problem.

The job of the therapist is not to answer the question why. It's to heal the eating disorder.

If the authors were up on the latest research on treating eating disorders, they wouldn't write, as they do, "Medication may be necessary either for the short term to facilitate treatment or for the long run to achieve emotional balance." While there are n o doubt people for whom medication is helpful, none of the big studies have shown any reason for routinely prescribing meds like Prozac and Paxil for those with eating disorders. This is not only wrong-headed advice--it's one size fits all advice.

The authors also recommend working with a dietitian or nutritionist--again, standard advice for someone with an e.d. They continue down the conventional path by recommending that the nutritionist and patient develop an eating plan together. This might be good advice for treating bulimia, but it's definitely not good advice for treating anorexia. And that's another of the problems with this book: The authors don't differentiate among the eating disorders.

I could go on, but you get the idea. No stars for this book.

Eating disorders workshops in central New York

The Mental Health Association of Onondaga County is offering a two-part Parent Partner Workshop, held on September 9 and 16th in Syracuse, NY. These three-hour workshops are designed to help families and loved ones support people with eating disorders, and I hope if you're in central NY you'll try to make one of the workshops. I'm thrilled that I've been asked to speak on the 16th. If you attend, please come say hello. I'll be talking about our family's experience with anorexia and about Maudsley Parents.

And the best part is that snacks are provided!

Details:
Sept. 9 & 16
6-9 p.m.
Cornell Cooperative Extension, 220 Herald Place, 2nd Floor, Syracuse
$10.00 per person, $30.00 for family of 4

Follow-up on A.

I emailed A. and heard back from her--a great email. She knows exactly what she's dealing with, with our family, and seems to have a pretty good handle on it.

And it seems that we can develop a relationship. I'm very glad.

Eating disorder studies

Hello all,

Here's your periodic roundup of research opportunities available in the e.d. world. We all know there is woefully little research on e.d.s--here's your chance to help make a difference. And maybe get some top-of-the-line free treatment.

Research Studies on Eating Disorders:

Clinics and Hospitals Team up to Study Eating Disorders: Six North American sites are teaming up to evaluate outpatient treatments for adolescents with anorexia nervosa. To date, this is the largest National Institute of Mental Health-funded anorexia nervosa treatment study. The study will allow for a thorough evaluation of two types of family therapy and will also test whether FDA approved antidepressant medication can enhance and prolong the result. The goal of the study is to improve recovery rates.

"Males and females ages 12 through 18 are the target population, because it is essential to identify and treat the illness in its early stage," says Craig Johnson, Ph.D., director and founder of Laureate Eating Disorders Program. He says that a parent may suspect anorexia nervosa if they have an underweight child that worries about their weight and appears to avoid food obsessively. Dr. Johnson and Ovidio Bermudez, M.D., internationally known eating disorder experts, are the principal investigators at Laureate for this study of two forms of outpatient family therapy. The treatments prescribed in the study, have been tested and shown to be helpful with patients in previous studies at Stanford University School of Medicine and The University of Chicago Hospitals.

After undergoing a screening process, families who qualify will be randomly assigned to one of four treatment combinations. The study is comprised of 16 one-hour family therapy sessions delivered over a nine-month time period and a medication (either fluoxetine or placebo) delivered over 15 months under close medical supervision. The family therapy sessions, medications and medication monitoring are all paid for by the NIMH grant.

This international eating disorders study is being coordinated by Stanford University, and includes six recruitment sites: University of California San Diego, Washington University School of Medicine in Saint Louis, Cornell Medical College, Toronto General Hospital, Sheppard Pratt Health System in Baltimore and Laureate Psychiatric Clinic and Hospital.

Individuals who suspect they might have anorexia nervosa, family members who believe their child may have the illness and physicians of potential patients are urged to call Nancy Morales, RN at 918-491-3722 to learn more about the study and/or apply for participation.



San Diego, CA: UCSD Researchers Seek Males and Females with Anorexia Nervosa: The UCSD researchers are currently seeking adolescents and adults currently suffering from Anorexia Nervosa to participate in one of their three current studies. To qualify for any of the studies one must be at least 15% below ideal body weight and be fearful of weight gain, despite being underweight. Both adults and adolescents between the ages of 14-45 are needed to participate in a taste study and would be compensated for up to $70 for completing the assessments, taste tests and interview. Adults 18 years of age and older are needed to participate in a randomized control trial of the medication Quetiapine, in which they will receive either the study medication or a placebo. Subjects will be compensated up to $360 for completing study related assessments and the medication treatment. In addition, they are offering several months of family therapy treatment for families with adolescents between the ages of 12 and 18 at no cost. The adolescents in this study will also be randomly assigned to receive either the medication Fluoxetine or a placebo. For more information, contact UCSD Eating Disorder Treatment and Research Program at 858-366-2525 or email edresearch@ucsd.edu.



San Diego, CA: UCSD Researchers Seek Women Recovered From an Eating Disorder: Help UCSD researchers understand what causes eating disorders. They are seeking female participants between 18 and 45 years of age who are recovered from Anorexia or Bulimia Nervosa. By participating in the study, subjects will be assisting physicians and researchers in developing new treatments for these complex and serious disorders. Subjects will be compensated for your participation in this study. For more information contact the UCSD Eating Disorder Research and Treatment Program at 858-366-2525 or email edresearch@ucsd.edu.



Massachusetts Research Study - Massachusetts General Hospital Study of Therapy for Bone Loss in Anorexia Nervosa: The Neuroendocrine Unit of Massachusetts General Hospital is conducting research studies on anorexia-induced bone loss. Their screening study is for men and women age 12-50 with anorexia nervosa. They are investigating causes of osteopenia (or bone loss) in the spine, hip, wrist and total body. The study involves one visit of approximately 3 hours. Their treatment study is for women aged 18-45 with anorexia nervosa and absent or irregular menstrual periods. They are investigating the combined use of a natural hormone and a medication that is effective for bone loss in postmenopausal women as a novel treatment for the bone loss seen in women with anorexia nervosa. They hope that the combination of these two investigational medications will help rebuild depleted bone and prevent further bone breakdown in women with anorexia nervosa. The study consists of 6 visits over 12 months. A stipend of up to $675 is awarded throughout the course of the study. If interested, call Erinne Meenaghan, N.P. at 617-724-7393 or email nedresearchstudies@partners.org.



Massachusetts: Bulimia Nervosa Study: Free confidential treatment is available to those who are eligible. Do you or someone you know binge eat? Do you or someone you know compensate by vomiting or other extremes? Do you or someone you know have severe moodiness or relationship problems? Researchers are now enrolling participants (ages 18-65) in a free treatment study investigating two active treatments, including education and counseling, for bulimia nervosa. If interested call 617-353-9610 or visit here.



New York, NY: NIMH-funded, IRB-Approved Study of Adolescents with Bulimia Nervosa (ages 12 - 21 years). This study takes place at NYSPI/Columbia University and compensation is provided for participation ($100). For more information, contact Laura Berner at 212-543-5316. P.I.: Rachel Marsh, Ph.D., Assistant Professor of Clinical Psychology, Columbia University/ New York State Psychiatric Institute, phone 212-543-5384, email marshr@childpsych.columbia.edu.



New York, NY: The National Institute of Mental Health is sponsoring a multi-center international study to compare two types of family therapy as well as fluoxetine or placebo (an inactive medication) in the treatment of adolescents with anorexia nervosa. They are looking for families with an adolescent with anorexia nervosa between the ages of 12-18 years. Participation involves completing assessment interviews, questionnaires, and engaging in 16 family therapy sessions over the course of nine months with medication continuing for another six months. The study is being held at the Eating Disorders Research Program, The Westchester Division of New York-Presbyterian Hospital, Weill Medical College of Cornell University. Contact the Research Coordinator, Samantha Berthod, MA at 914-997-4395.



Pittsburgh PA. Seeking Women Recovered from Anorexia or Bulimia Nervosa. Dr. Walter Kaye and his research team at the Eating Disorders Research Program at the University Pittsburgh Medical Center are looking for women who have recovered from anorexia or bulimia nervosa for a research study on brain chemistry in eating disorders. Study participants must be between 18 and 45 years old, medication free (birth control pills acceptable) and not pregnant or nursing. The study involves phone interviews, questionnaires, PET and MRI scans, lab work, physical exam, two visits to Pittsburgh and 8 weeks of fluoxetine (generic form of Prozac). (Note: All expenses incurred during the study, e.g. travel expenses, lab work, physical exam and etc. are paid for by the study.) In addition, eligible participants will be compensated up to $1300 upon completion of the study. For more information, email EDResearch@upmc.edu or Dr. Kathy Plotnicov at plotnicovkh@upmc.edu or Dr. Sharon Barnes at barnessd@upmc.edu. Interested parties can also call toll-free at 1-866-265-9289 or submit a contact form online here.