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The section on treatment is just as outdated and even harmful.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.