Anorexia and target weights

Doctors do a lousy job, overall, at setting target weights for people recovering from anorexia. Most set them way too low, so the patient never reaches or stays at a weight high enough to heal from prolonged malnutrition, and relapses.

Now a new study published in the International Journal of Eating Disorders suggests a different measure of recovery: resumption of menstruation.

As nearly any pediatrician or parent can tell you, this is a bad idea. Really bad idea. Some girls never lose their periods no matter how much weight they lose. Some get them back while they're still significantly underweight. Getting your period back while you're in recovery is a good sign, but it's no litmus test of health.

In fact there is no single measure of restored health. Some clinics use body composition analysis, which takes into account not just a person's weight or BMI but also the percentage of lean and fat tissue in the body.

I think the best measure is mental health, and parents are well-placed to judge it. They know what their child was like before anorexia, and they know when their child is "back." I've heard countless stories of teens who reach the weight the doctor sets and still aren't better, or who get their periods back despite still being in the grip of anorexic delusions and obsessions.

When I saw my daughter's anxiety around food and eating was pretty much gone, I knew she was close to full recovery. Don't settle for anything less.

And the winners are . . .

You all could be making tons of money as high-paid marketing shills for Big Pharma. But I'm glad you're not.

And the winners of the Taranabant marketing slogan contest are:

Letitshine's "Taranabant: Because food is bad." Because, you know, that's what people really really think, deep down.

bigmovesbabe's "Taranabant: Because nothing tastes as good as anxiety feels." For its social satire of That Other Tagline.

And finally, littlem's "Taranabant: Rimonabant Duzn't Wurk On Fattiez, So We Tryz Agen" just because I think it's hilarious. And oh so true.

I'll award more prizes if you keep the entries coming. Meanwhile, congratulations to our 3 lucky winners. Send me your address and T-shirt size and I'll send you a prize. :-)

Would you rather be fat or have a mood disorder? Win a prize!

Because those are your two choices, if you listen to the hype around the latest in the slew of anti-obesity sweepstakes entrants, known generically as taranabant. Amid the hysterical buzz that's been making the rounds online, we're now beginning to see mention of "psychiatric side effects." This Scientific American article describes side effects as "nausea, vomiting, and moodiness," and goes on to explain that taranabant is what's known as a cannabinoid antagonist, meaning it blocks the receptors in the brain that are activated by cannabis sativa, or pot. So instead of giving you the munchies, this drug takes away appetite; instead of calming, it "activates," or makes people irritable and anxious.

But wait--I have a better idea. And you can win a prize! Keep reading.

Can me say first how much I hate the photo and headline that ran with this story, too? The head was "New Diet Drug in the Battle of the Bulge," and it ran with this image.

My interpretation of the phrase "battle of the bulge" is people who want to lose 10 or 20 or 30 pounds—who want to be in the lower end of their setpoint range rather than the higher end. This is hardly what even the medical profession would label "obesity." I suppose this image is better than the one that ran with a report on a site called Dogflu.ca., which I'm not going to reproduce here because it's so exploitative.

I think we need an anti-anti-obesity drug marketing campaign, and drugs like this give us the perfect material. We could start by resurrecting the old "This is your brain on drugs" ad campaign. See the fun that's possible?

Let's have a little friendly competition, in fact. You write a clever tagline to go with this new drug, and I'll send a prize to a couple of lucky winners. Ready, set, go.

Why we need to talk about food

Over at Laura Collins' blog there's a compelling debate raging about treatment for eating disorders. It started with a link to a Student Doctor Network discussion about Maudsley (also known as family-based treatment).

The forum link is a peek into the minds of some medical/psych students who dismiss Maudsley treatment as something that might work only for "the very tame cases" (has anyone out there ever seen a "very tame case" of anorexia?). Students who know nothing about it say confidently that they would "never recommend it."

I would think that given the truly abysmal rates of recovery from eating disorders, medical professionals would be thrilled to learn about a treatment with positive results and an excellent track record. I've got a couple of suggestions for where to start: With this useful Q&A on Maudsley and this article about the University of Chicago's Daniel Le Grange.

And in answer to a comment made on the Student Doctor Network, I love what Dr. Le Grange says at the end of the article: "How can you not talk about food when your daughter is starving?"

Pop quiz

What's the first thing that pops into your head when you think about eating disorders? Or see someone who's clearly struggling with anorexia or bulimia?

A. "What a selfish brat--why doesn't she get a life?"

B. "What a dreadful illness this is--I know how much she's suffering"?

The answer most likely depends on what you know--or think you know--about eating disorders.

If you think they're emotional responses to trauma or lifestyle choices, you probably answered A. If think they're physiological diseases that are no fault of the patient and can't be chosen (or unchosen), you probably chose B. And you'd be correct.

As Cynthia Bulik, professor of eating disorders and psychiatry at University of North Carolina, put it, "“There is a lot of false information about anorexia nervosa disseminated in pop culture. This study suggests that even a nugget of accurate biological information can influence how health care professionals perceive the illness."

And not just doctors and nurses but real people, too, according to the experiment Bulik is commenting on. Attitudinal change comes hard, but it does happen. Read and rejoice.

Body image/sexuality 101--for teens

Here at Feed Me!, I get a lot of books sent to me by publishers and authors who want some blogosphere buzz. I write only about the ones that really move me--negatively or otherwise--because life's just too short to bother with the rest.

Body Drama by Nancy Amanda Redd is the most recent submission that's come my way, and I thought it would be perfect to try out on my two teenage daughters. They're a tough audience, as most teens are these days, quick to spot the phony tone and the overly chirpy (and uninformative) information. This book is, as it trumpets, designed for "Real girls, real bodies, real issues, real answers," and its cover features tasteful images of 5 teenage girls in their underwear, along with the tagline "Shape * Skin * Down there * Boobs * Hair & Nails."

I like the book a lot, for its joyful photos of bodies of all shapes and sizes, for its common-sense, practical advice, and for its willingness to take on some tough questions and provide elegant, useful answers. One of my favorite pages shows photographs of 24 different vulvas of all shapes and sizes. "When I study the different vulvas, I see elements of my own here and there, and realize that no one's exactly the same" writes Redd, a former Miss America contestant and Harvard grad. "I also have been able to release a lot of the embarrassment I always carried around about my own vag. I hope that these pages will do the same for you."

But what would my daughters think?

I brought the book down to the living room one afternoon and put it on a table. Within 10 minutes both girls had picked it up--a promising beginning. The 16-year-old dismissed it by saying, "I know all that already." But I noticed she kept going back to it, picking it up, paging through it. The younger one didn't want to pick it up, so I wound up asking her to take a look. She read it cover to cover and told me later, "That book was pretty good."

Bottom line: If you've got teenage or preteen daughters, you might want to buy this book and leave it lying around. At the very least they'll see that not everyone looks like Paris Hilton (thank God).