Walt Kaye, M.D., believes in families

Dr. Kaye, a professor of psychiatry and director of the Eating Disorders Program at University of California-San Diego, is leading a team in one of the largest studies on eating disorders ever done. The study will include seven sites around the world and will compare two kinds of family therapy to explore the question of which kind of family therapy is best for which families.

Note to eating disorders therapists and programs: The question in this study isn't whether families should be part of e.d. recovery. It's how.

Patients will be assigned to one of two treatment types: systemic family therapy, which looks to improve relationships within the family as a means to recovery, and family-based treatment, also known as the Maudsley approach, which empowers the family to help the child recover.

One of the biggest perceived obstacles to Maudsley treatment is the notion that families have to be "perfect" in order to implement it. Well, that and the traditional notion that families cause eating disorders in the first place, and so cannot possibly be part of the solution.

The trouble is, traditional treatments stink. They condemn sufferers to years of semi-starvation, partial recovery, and inevitable relapse. So far, the Maudsley approach is the single most effective treatment for teens, with five-year recovery rates between 80 and 90 percent.

If a better treatment came along, I'd be the first to do the happy dance. What I can't stand is people who shoot down the notion of families being involved in treatment on general principle, or because it's always been done that way, or because they've always done it differently and can't make the leap to a new paradigm.

Children deserve the best treatment out there. Research shows that if someone with anorexia is ill for less than three years and then recovers, her chances of a lifetime free of this devastating illness are excellent. But those who've been chronically ill for 5 years, 10 years, 15 years, are much less likely to ever really recover.

And that's simply wrong. Especially when there are tools that can help--like the family.

Anyone who's interested in being part of the UC-San Diego trial can call 858-366-2525 or e-mail edresearch@ucsd.edu.

What does it all mean?

A reader named Moira wrote in on another thread, and I thought her comment deserved its own post:

Hi. My name is Moira, and I couldn't help noticing your comment that the BMI for overweight was lowered to 25 and obesity at 30. I've also noticed in my line of work that doctors lowered what the accepted upper limit for blood pressure should be as well, from 140/90 to 130/80. And just the other day I was called full figured for the first time in my life. What does it all mean? Is there someone out there who wants me to believe that every one of us has a problem needing intervention when we might just be fine as we are?

In a word, yes I do think that. Think about how other criteria have changed over the last decade or so, too, from cholesterol guidelines to blood sugar guidelines to weight guidelines. Ask yourself if it's really credible that most adults in the U.S. need to be on medication for cholesterol, high blood pressure, and other issues. Then ask yourself the classic question in any criminal case: Cui bono? Who benefits?

Big Pharma benefits, that's who. The health care industry benefits from the medicalization of all kinds of things, from childbirth to body size. Maybe it's useful to see the current anti-obesity hysteria as part of this overall trend toward pathologizing normal human variances and processes. After all, as soon as you identify a "normal" range of anything, you automatically create an "abnormal" range as well.

What do you all think?

Support group meeting tonight

Sorry for the late notice--the Madison, Wisconsin support group of parents of children with eating disorders is meeting tonight. This is a loose, informal group that i've convened. We share resources and support, especially around family-based treatment (the Maudsley approach). Please stop by if you're in the area. The meeting is at Barriques on Monroe Street at 7:30.

A little question of semantics

When I showed my daughter the NYT piece on the fatosphere the other day, her only comment was, "But you're not fat."

What she meant, of course, was "You're not that fat."

Put me next to, say, Ellen Pompano, and I certainly look fat. Put me next to someone who weighs 400 pounds and I don't look fat. Or I don't look as fat.

Fat and thin are words that exist mainly in relation to each other. At the extremes of each range we can certainly identify them correctly. But in the vast middle, our judgment becomes much more relative.

Semantics plays a role in the current anti-obesity hysteria. For starters, the definitions and rules changed in 1998, when the cutoff for overweight was lowered from 27.3 to 25 on the BMI chart. Bingo--instant overnight overweight for millions.

As Paul Campos has pointed out in The New Republic, the way we talk about fat and thin, oveweight and obese and underweight, is something of a shell game.

Fat qua fat is not the problem. Because, after all, we all have fat on our bodies. What's more, we need fat. Without it, your body doesn't work well and your brain sure as hell doesn't work right. I've seen the evidence up close and personal, and it's not pretty.

Think about it the next time you find yourself saying, "But I'm so fat!" or the next time you look in the mirror. Come back and tell me how it changed your perception.

We interrupt this blog to tell you

that I've had to enable comments moderation for the time being, due to an influx of ungrammatical and highly offensive comments.

Sorry for the inconvenience. I'm sure they'll find someone else to pick on soon and stop leaving their illiterate offerings, and then I'll go back to an open comments policy.

Anti-fatism up close and personal

My experience last night with the shock jock from Philly reminded me of an experience I had as a child. I went to an elementary school where we spoke English in the morning and Hebrew in the afternoon, and where pretty much everyone I knew was Jewish. My parents talked a lot about anti-Semitism, but I never encountered it.

Until I entered 7th grade at the local junior high, and one day, as I walked down the hall, a group of laughing 8th graders showered me with pennies and shouted, "Run for the pennies, kike!"

I was so naive I was more puzzled than upset. What was a kike? I didn't even know.

Once I found out, the waves of shame and humiliation took a long time to diminish.

That's how last night's radio show was for me--really the first time I've encountered fatism in such a virulent form, especially as followed up by a commenter this morning. (Alex from Philly, don't even bother. You'll be deleted and go straight to troll hell.) It's hard to take it in when you meet up with such hatred, whether it's based on the color of your skin, your religion, or the size of your waist.

Years after that day in junior high, I realized what's at the heart of all such prejudice and hatred: self-loathing.

If I were a more generous person, I'd feel compassion for all those who spew mindless hatred because they're secretly afraid they themselves don't measure up, because they hate themselves. But you know what? I'm not feeling particularly generous today, so I'll leave it at "I hope you get yourself some help."

Why talk radio sucks

I just learned Media Lesson 101: Never go on a talk radio show without asking who else is going to be on.

When the Dom Giordano Show emailed today to ask if I would come on the show this evening to talk about today's New York Times piece about the fatosphere, I figured it would be the usual five-minute radio interview, with time for a couple of comments about the piece and the fatosphere.

What they didn't tell me is that there was going to be another guest, a fitness trainer and "expert" whom they have on the show often.

Instead of a civil conversation, we had a lotta fatty mudslinging, complete with descriptions of waddling children, fatties who just want an excuse to be obese, etc. I was blindsided by the vitriolic assumptions that got tossed around. It was a classic exercise in thin entitlement and fat-bashing, all couched in the usual "Don't you know fat is unhealthy?" language.

I'm mad at myself for missing some opportunities, because my heart was banging away and my voice was shaking. Nothing like a shock jock to raise the adrenaline level. Not that it mattered--the research I was able to pull out of the air and cite (the 2005 CDC mortality study, for one) just sailed on by as if it didn't exist. And it didn't, you know, because of the waddling children and diabetic fatties who can't get off the couch. When I suggested that you can be healthy and fit even if you're fat, they practically laughed me off the show.

I feel badly about this--I could have done a better job of advocacy.

I hope the rest of you FA bloggers don't get blindsided like this. And I hope there was one person listening who heard a little something new, and might check it out.

Ugh. I'm heading upstairs to do some yoga. What an end to what a day.

Welcome new readers

Some of you have arrived here via the New York Times piece on the fatosphere. Some have come from other blogs, like Shapely Prose or Manolo for the Big Girl or Creamy Nougat Lair. However you stumbled onto this blog, I'm glad you're here.

I hope you'll take a few minutes to read up on the I Love My Body! pledge. Subversive, isn't it? Especially when you think about the messages the rest of the world gives us every single http://www.blogger.com/img/gl.link.gifday. Lose weight. You're too fat. You're worthless if you're fat. Thin = pretty. Thin = sexually attractive. Fat is repulsive, dangerous, unhealthy, ugly.

Here at Feed Me!, we believe in Health at Every Size. When our friends make comments filled with self-loathing, we talk them off the ledge. We believe that each and every one of us deserves a joyful, competent relationship with food.

I've been researching and writing about issues of weight and body image for several years, including this story about my daughter Kitty and her struggle to recover from anorexia. I'm putting together an anthology of essays about these issues, called--what else?--FEED ME!, which will be published by Random House next December.

I'd love to hear from you. What's your relationship with food and eating and your body like? What challenges you and what brings you joy? Share it with the community here. You won't be sorry.

Love Your Body!

As Camryn Manheim said, This is for all the fat girls. And the thin girls. And the in-between girls who struggle, as so many of us do, with self-loathing.

Well, here's a way to fight back.

Print this out. Use it as a bookmark. Tape it to your fridge. Frame it for your bedside table. Say it out loud.

I promise you, someday you'll actually believe it.

In honor of MLK Day

And in the context of the ongoing discussion about fat acceptance as a civil rights movement, here are some excerpts from Dr. Martin Luther King Jr.'s "Letter From Birmingham Jail." This particular section addresses the question so often asked in the civil rights movement of the 1960s: Why not just wait, things are getting better, why push it? King's eloquent and beautiful response is moving and righteous.

We still have so long so go for racial equality in this country. And if, as you're reading King's words, you imagine the word fat everywhere he writes Negro, and thin for white, you might get a taste of the work that still needs to be done on other fronts, too.


Letter From Birmingham Jail
April 16, 1963

You may well ask: "Why direct action? Why sit-ins, marches, and so forth? Isn't negotiation a better path?" You are quite right in calling for negotiation. Indeed, this is the very purpose of direct action. Nonviolent direct action seeks to create such a crisis and foster such a tension that a community which has constantly refused to negotiate is forced to confront the issue. It seeks so to dramatize the issue that it can no longer be ignored. . . . I must confess that I am not afraid of the word "tension." I have earnestly opposed violent tension, but there is a type of constructive, nonviolent tension which is necessary for growth. Just as Socrates felt that it was necessary to create a tension in the mind so that individuals could rise from the bondage of myths and half-truths to the unfettered realm of creative analysis and objective appraisal, so must we see the need for nonviolent gadflies to create the kind of tension in society that will help men rise from the dark depths of prejudice and racism to the majestic heights of understanding and brotherhood.

The purpose of our direct-action program is to create a situation so crisis-packed that it will inevitably open the door to negotiation. . . . My friends, I must say to you that we have no made a single gain in civil rights without determined legal and nonviolent pressure. Lamentably, it is an historical fact that privileged groups seldom give up their privileges voluntarily.

We know through painful experience that freedom is never voluntarily given by the oppressor, it must be demanded by the oppressed. . . .

Let us all hope that the dark clouds of racial prejudice will soon pass away and the deep fog of misunderstanding will be lifted from our fear-drenched communities, and in some not too distant tomorrow the radiant stars of love and brotherhood will shine over our great nation with all their scintillating beauty.

Yours for the cause of Peace and Brotherhood, Martin Luther King, Jr.

Et tu, Prevention?

It's been a while since this magazine geek has looked at Prevention magazine. What I remember from the last time--maybe 10 years ago--was that Prevention was a pretty good health-related magazine, with in-depth articles, exposés, thoughtful journalism, and some reader service--the tips and tricks kinds of articles.

This evening I looked it up online; I'd been told there was an article in the current issue I should see. I got to Prevention's home page, and was immediately assaulted by the following headlines:

Kick-Start Your Metabolism!
Flat Belly Diet! Tips to Shed Pounds Fast
Eat Chocolate to Lose Weight
Calculate Your BMI
Eat Healthfully and Fight Disease
Heart-Smart Foods
Melt Fat With Every Step
Lose Up to 15 Pounds in 32 Days
Eat Up, Slim Down

Dear editors: There's more to life than obsessing over fat and weight loss. You'd think, reading this page (and this was just the home page--there's more farther in), that losing weight was the only meaningful measure of health.

Seeing it like this was a visceral reminder of our national obsession, and just how unhealthy it is.