Anorexia ≠ autism

Of late, several researchers have been exploring a possible link between anorexia nervosa and autism spectrum disorders. I've never understood why. It seems fairly clear to me that acute anorexia brings with it an altered state of consciousness that has little to do with a person's ordinary state of mind or ability to interact with people. In his seminal study on human starvation, researcher Ancel Keys noted that those in the throes of semi-starvation tend to lose both the interest in social interactions and the ability to pull them off. That certainly echoes my own observations.

Now, thankfully, researchers at King's College in London have come to the same conclusion. The study's authors write, "These findings indicate almost complete normalization of emotion recognition ability in recovered patients, despite the observation of difficulties in both domains in currently ill patients. Findings suggest that similarities between AN and ASD are restricted to the currently ill AN state and such difficulties in AN may be a factor of starvation."

Now, can we move on to more fruitful avenues of research, please? Like developing effective treatments?

"Plus-sized" models in a mag spread

While I question the plus-sized designation on some of these women (one is a size 10, which is plus-sized only in the insane world of fashion), I love these elegant spreads from an Australian magazine called Madison. A shout-out to Australian blogger Julie Parker for linking them on her blog, Beautiful You.

Follow-up: Lincoln University

According to the Associated Press, Lincoln University has dropped its requirement for fat students to take a special fitness class.

But, you know, they still don't get it. Because apparently, some freshmen will have the course "suggested" to them after they take a health class.

Dudes, when are you gonna cotton on? If the class is really all about health, and you think it's important, all students should take it.

And if it's all about weight loss? No students should take it.

A few thoughts on "refusal"

One of my gripes with the current thinking about eating disorders lies in the very definition of anorexia nervosa, as found in DSM-IV, the psychiatric bible:

Refusal to maintain body weight at or above a minimally normal weight for age and height.

It's the word refusal, frankly, that bugs the hell out of me, with its implication of volition. It suggests that people with anorexia nervosa could maintain their body weight, if they really really wanted to, which suggests, in turn, that AN is a disease of choice.

Nothing, in my experience, could be further from the truth.

So I was delighted to read, in the November issue of the International Journal of Eating Disorders, a literature review by Harvard Medical Schools' Dr. Anne Becker recommending that the word be changed in the next edition of the DSM. According to Becker, "The term 'refusal" in AN criterion A is potentially inaccurate, misleading, and pejorative." Woo-hoo! It doesn't get any more straightforward than that.

Becker, et. al., go on to write:

By implying agency and willfulness, the phrasing . . . may promote stigmatization of AN. In particular, the connotation of the word 'refusal' as behavior that is oppositional may perpetuate the notion that a patient is in control of her symptoms. Research has highlighted the stigmatization of AN both by the public, who appear likely to blame the patient for her illness and to believe she could "pull herself together" if she so desired, and by medical professionals.

Thank you, Dr. Becker, for setting the record straight. May the rest of the ED treatment community take your words to heart.

Lincoln University: Epic fail

Lincoln University, a historically black college in southern Pennsylvania, has made the news recently for jumping on the now-mandatory "wellness" bandwagon. As reported in the Chronicle of Higher Education, Lincoln's version is to institute a policy of weighing and measuring all freshmen; those with BMIs over 30 are required to take a one-credit course called "Fitness for Life" sometime before they graduate.

This policy exemplifies the worst of what's wrong with the way we as a culture approach fitness, health, and wellness. Like so many other institutions jumping on this bandwagon, Lincoln makes a fatal error in logic: It conflates weight with fitness.

So heavier freshmen at Lincoln are assumed to be "unfit" and "unhealthy." Just as bad, thinner freshmen are given a pass on the fitness course, the assumption being that they don't need it because they're not that fat.

If fitness and good health are the goals, shouldn't everyone have to take the course?

Some people object to the fitness course on libertarian grounds. Not me. I think good health and fitness is part of what we should be teaching children and practicing ourselves. But threatening or punishing larger people because of their size is not a useful strategy. As a researcher from the National Institutes of Health said recently, the number-one cause of obesity in this country is dieting. Programs like this buy in to the fat-is-unhealthy mindset. They also buy in to the thin-is-healthy mindset. By conflating weight with disease they do everyone a grave disservice.

My own school, Syracuse University, is looking at "wellness" programs right now. I hope I don't have to write a piece like this about SU someday.

PSA: Why you should always hire a trained journalist

Because if you don't, your newscasts will look like this.

BODYTALK: The video

Sara Sultanik, a talented grad student here at Newhouse, put together this cool video about the BODYTALK project. Thanks, Sara!

Everyone else--what are you waiting for? I'd love to get an MP3 from you for the BODYTALK project.

Newsflash: HAES Really Works!

At least, according to researchers at Laval University in Quebec, who have just published the results of a randomized trial comparing Health at Every Size with other food-related interventions.

The study involved premenopausal women considered overweight or obese, who spent time either in an HAES group, a support group, or a control group. A year after the trial had ended, the women in the HAES group had less "situational susceptibility to disinhibition," meaning they were less likely than women in the other two groups to overeat when triggered by stress, abundance, and other external situations. Women in both the HAES and support groups ate less in response to perceptions of hunger.

I'm a little irked that the ScienceDaily writeup of the study refers to HAES as a "new weight paradigm." But hey, it's still good news, and the beginning, I hope, of more studies looking at the benefits of HAES. Now, if only I could get these study results to the last group of doctors I spoke to . . .

Project BODYTALK: Anyone can record a commentary

I was interviewed this morning for the SU campus newspaper about Project BODYTALK. The reporter asked me an interesting question: Do I think that the act of telling your story around food and body image is healing? Is that what I hope to accomplish through this project--healing for the people who tell their stories?

My answer: Absolutely. But I also know that healing--in whatever form--will also happen through listening to these powerful stories.

To that end, I'd like to collect as many commentaries as possible. You don't have to have an eating disorder or serious body image issue to tell your story--in fact, I'd like to hear from people who feel good about their bodies, too!

Project BODYTALK starts today on the Syracuse University campus--but you don't have to come to campus to participate. Record your commentary in the privacy of your own living room and send it to me as an MP3 file. Please say your name and age at the start of the recording; if you want to remain anonymous, say that on the file too, and I'll edit it out.

If you want to submit a file, send it to hnbrown at syr dot edu.

If you're in or near Syracuse, come on down to the BODYTALK audiobooth any day this week or next between 3 and 8 p.m.: Newhouse 2, Room 472, studio P.

I hope to hear your story.

The BODYTALK project

If you live in central New York, please come participate in the BODYTALK project at Syracuse University. It's modeled after NPR's Storycorps booth, a traveling audio booth where people could record anonymous commentaries about things that mattered to them.

BODYTALK gives people a chance to record commentaries about their relationships with their bodies, appearances, food, eating, and weight. For the first two weeks of November, a recording studio at SU's Newhouse School of Public Communications (where I teach) will be set aside for anyone who wants to record a commentary. You can give your name or do it anonymously. Some commentaries will air on NPR's national show 51%; others will, I hope, be published eventually on a website.

If you can't get to Syracuse, you can record your own commentary and send me the mp3 file. I'd love to have as many people as possible take part in the project.

Who: Anyone!
What: Record a commentary (between 3 and 10 minutes long) in
Newhouse 2, Room 472, Suite P
When: Nov. 2-13; most days 3-8 p.m. (sign up at suite P, or walk
in at any time)

Because the more we talk about these feelings, the more shame and stigma will fall away.


*Photo originally published by Roosevelt University.

Help a grad student

Tina Indalecio, who's getting her PhD at Fielding Graduate University, is running a survey on how advertising media affects people with eating disorder or body image issues. I'm all for anything that helps with research around eating disorders, because God knows there's not very much of it.

So if you'd like to help Tina, you can read more about her research and/or take her survey here. The password you'll need is temp1212. The deadline for participating is Wednesday, October 28, by 11:45p.m.

You can also check out Tina's blog here, and her documentary project here.

Watch and learn

Even I'm surprised by some of what I saw in another of the Dove Campaign for Real Beauty videos. . . .




**Thanks, Erik, for sending it my way.

Interview with Dr. Katharine Loeb

Here's the latest in a series of video interviews with some of the top researchers in the field of eating disorders, done by Jane Cawley, co-chair of Maudsley Parents. This interview with Dr. Katharine Loeb of the Mt. Sinai School of Medicine offers sound, practical advice for parents of teens with anorexia.

Anorexia Nervosa in Teens: What Parents Should Know from Jane Cawley on Vimeo.

Take a look. Let me know what you think.

In honor of the High Holidays. . . .

Long before anorexia came to our house, I refused to fast on Yom Kippur. I understand the idea behind a 24-hour fast: to "cleanse" the mind of its emphasis on the corporeal, and to refocus it for a time on the spiritual.

For me, though, a fast made me think more about my body and its needs, not less. Standing in synagogue, beating my breast, all I could think about was food and hunger.

At 13, the first year I was "allowed" to fast, I became so ill with hunger that sometime during that long afternoon, I ate part of a candy bar I found buried in the sandbox behind our synagogue, and spent the rest of the night throwing up.

Personally, I'm much more able to feel spiritual when I'm well fed, well rested, and centered.

Jews wish one another an easy fast in honor of Yom Kippur. Since I don't fast--and since I hope those of you who are actively dealing with an eating disorder are not fasting either--I will wish you instead a day of contemplation, of connection to yourself and others, and a refocusing on your true appetites, whether they are spiritual, physical, emotional, or creative. Whatever your concept of holiness, I hope you can find some corner of it today.

To help you along, here's a gorgeous recording of Jacqueline du Pre playing Kol Nidre, courtesy of my friend Kay.

Scared straight?

These kind of scare tactics are, after all, the logical extension of the "war on obesity."

Only the author of this little news item is forgetting something rather important: food and cigarettes don't play the same role in a human being's life. You can live (much better, thank you) without smoking. You can't live without eating.

So what, exactly, is this fear-mongering supposed to accomplish? How about a new generation of disordered eaters? Oh, right, we've already got that. So . . . what's left? A new diagnosis for DSM-V--cibuphobia?*

*Cibus = latin for "food"

For all the perfectionists out there . . .

I believe this with all my heart.

If you never fail, you aren't living.




**Thanks, Shander!

New research study

If you struggle with binge eating disorder and live in the Boston area, this study might be of interest. You've got to be between 18 and 50 years old and a non-smoker, at least for the last six months. For more details, see the study posting.

I'm a fan of taking part in research studies-IF they offer you something useful.

For information contact Miguel Alonso-Alonso, malonso@bidmc.harvard.edu.

Just when you think you've seen it all . . .

comes this appalling cookbook, Hungry Girl, which touts itself as offering 200 recipes under 200 calories each.

The title says it all, to my mind: Hungry girl. Is that what we're aiming for here? To make sure girls stay hungry? Not to mention malnourished, obsessed, and generally distracted from more important matters?

Just think of all that women could achieve--women, not girls--if they weren't hungry all the time, or thinking about food, or worrying about what they're eating or not eating.

Imagine.




**Thanks to Katie Dummond.

"You've lost weight!"

That's what a colleague said to me yesterday, a woman I haven't seen for six months. A woman who is tall and broad and neither thin nor fat.

I haven't lost weight; if anything, I've probably gained a pound or two. Which is irrelevant, really, because I've had people say this to me whether I've lost or gained or stayed exactly the same.

And it's a comment I never know how to respond to, because there are so many assumptions wrapped up with those three little words: The assumption that I'm trying to lose weight, or at least wishing to. The assumption that losing weight will make me look better. That assumption that losing weight, or trying to, is a positive thing. The assumption that it's OK for someone I don't know well to comment on my appearance.

I've considered a variety of responses to this comment, everything from "Please don't comment on my appearance" to "Thanks." What I said yesterday was a simple, "Actually, I haven't."

My colleague persisted. "No, you really have," she said. "You look--" She gestured toward my body. "Maybe it's the shirt," she said.

"Maybe," I said. I walked away feeling ungracious. Should I have said thank you? In our culture, telling a woman she's lost weight--especially a woman who is not thin--is a compliment and a social offering. I like this colleague a lot; I know she meant well. Yet I'm very uncomfortable at this point with comments like this. They are also teachable moments. But, you know, sometimes I get really tired of teaching.

I'm not sure I said the right thing. I'm not sure what the right thing is. Any thoughts?

Have you ever been on the receiving end of weight-based discrimination?

If so, I'd like to hear from you. I'm doing a story for the NY Times science section on this and would like an anecdote or two, especially having to do with work, jobs, etc.

Email me at harriet at harrietbrown dot com.

What the World Eats

Today I stumbled onto this fascinating excerpt from a book called Hungry Planet, which was serialized on the Time magazine website when it came out a few years ago. Photographer Peter Menzel and writer Faith D'Alusio visited 30 families in 24 countries to research this collection of portraits. Each family is shown with a week's worth of food, along with the cost of that food (in local money and in U.S. dollars), plus a list of the family's favorite foods and/or recipes.

The photos are eye-opening, literally, especially when you compare, say, the abundance and variety of foods eaten by a family of four in Germany (cost: about $500 a week) with the much more meager and monotonous foods eaten by a family of five in Chad (cost: $1.23). The lists of favorite foods include everything from rice to polar bear to pastries.

There's something quite wonderful about the way these photos show us, without posturing or judgment or politics, each family's relationship with food. I was especially captivated by this as I've been contemplating a similar personal photo project. But this is so much better.

Is Your Child One of the 12 Percent?

One of the things you hear a lot these days--at least if you spend any time talking to doctors about eating disorders--is that they affect a relatively small number of kids. Prevalence rates for anorexia are usually quoted as .5 to 1 percent, and 3 to 6 percent for bulimia. (Binge eating disorder is a newer diagnosis; I've heard 3 percent for BED but don't know if it's accurate.) Which somehow makes them less worthy of attention, concern, and research money than, say, childhood obesity, which as we all know is public healthy enemy #1. (That's sarcasm, y'all.)

But a new study out of University of Texas at Austin shows that fully 12 percent of all adolescents experience some form of eating disorder. That's 12 out of 100. Which may not sound like much.

But consider that 1 out of 15,000 kids gets cancer of some kind, and think about the attention and research and money devoted to understanding and treating childhood cancers. Then think again about the number: 12 percent.

It sounds a lot bigger now.

One of the pervasive problems in treating eating disorders is a lack of effective treatments. We need more research, which needs we need more research dollars. One reason we don't get those dollars is that families are often reluctant to acknowledge that their child has an eating disorder because of the stigma associated with these illnesses.

Cancer used to carry a lot of stigma, too. As a culture we've mostly gotten over that. How about we start challenging the stereotypes around eating disorders? Parents could be amazing advocates, if only we were willing to stand up and say, "Yes, my child is one of the 12 percent--now what are we going to do about it?"

How about it?

See you in . . . October?

For those of you in the D.C. area, I hope you'll join me and some very special guests at a conference on eating disorders, hosted by Maudsley Parents. This half-day get-together features two of the leading researchers in the field of eating disorders, both of whom are accessible, compelling speakers. Daniel le Grange heads up the University of Chicago's Eating Disorders Program; Walter Kaye directs the University of CalIfornia-San Diego's program.

Dr. le Grange will discuss family-based treatment (the Maudsley approach) for both anorexia and bulimia. Dr. Kaye will give us insights into the neurobiology of eating disorders. And I'll share my family's story and offer parents specific strategies and tips for helping a child through an eating disorder.

You can find more information and sign up for the conference here. (If you sign up before September 14, the cost is only $25 per person.) I hope to see you there!

Et tu, New York Times?

Funny--I just spent an hour on the radio talking about the stigma of being fat, and lo and behold, this incredibly mean-spirited snarky piece appears in the New York Times.

I'm happy to see that Jezebel called the Times out for this offensive story, which includes paragraphs like this one:

The petites section features a bounty of items for women nearly as wide as they are tall; the men’s Big & Tall section has shirts that could house two or three Shaquilles. And this is really, remarkably smart.

The writer, Cintra Wilson, seems unfamiliar with the concept that fat people wear clothes and spend money too.

I think this is a job for the Times' public editor, don't you? You can email Clark Hoyt at public@nytimes.com.

Fat acceptance on Radio Times

I just finished doing a call-in show on Radio Times, a public radio show on WHYY, on fat acceptance and on our relationship to food and eating and weight. It was a good show, and included some excellent comments from Rebecca Puhl of the Rudd Center for Food Policy and Obesity at Yale.

You should be able to listen to an archived version of the show here eventually.

I thought it was interesting, and somewhat sad, that pretty much all the callers espoused the "thin-is-healthy" and "thin-at-any-cost" idea. For those of you who may be finding this blog after hearing the show, I'd love to direct you to a couple of good resources.

I hope you'll check out Ellyn Satter's wonderful website and books. Satter, a nutritionist, therapist, and researcher, advocates for what she calls competent eating--meaning, eating in a way that satisfies your hunger and your appetite. She writes about the need to develop a joyful relationship with food and eating--a radical concept in our current culture, and one worth considering.

One of the callers mentioned anger and snarkiness among the Fat Acceptance blogs. I don't know how you define snarkiness, exactly, but I quite like some of the FA blogs, including Shapely Prose, The F-Word, and The Fat Nutritionist.

Finally, in my recent book, Feed Me: Writers Dish About Food, Eating, Weight, and Body Image, I published a Love-Your-Body pledge, which is also available here. I hope you'll consider signing it. Paste it up where you'll see it everyday, and remind yourself about what you love and appreciate about your body.

Bob Herbert: What he said

Read it here.

Thanks, Bob.

Obesity & eating disorders: the link

Researchers at the University of Minnesota (where, 60 years ago, Ancel Keys did his pioneering work on starvation) are beginning to quantify the links between overweight and eating disorders in kids. Their newest study looks at the risk factors that make overweight teens vulnerable to behaviors that are part of eating disorders: self-induced vomiting, using diet pills and laxatives, and binge eating. They also look at socio-cultural factors that contribute--reading a lot of magazines articles about dieting, for instance.

The research is led by Dianne Neumark-Sztainer, who's done some excellent work on weight over the years. It's worth checking out, especially in light of our current hysteria around obesity and the plethora of intervention efforts aimed at kids, which I fear are creating a tidal wave of eating disorders. (They certainly don't make kids thinner.)




Thanks to Jane for pointing out this research!

Save the date: October 5

Please join Maudsley Parents for a half-day afternoon conference on family-based eating disorders featuring two of the research world's heaviest hitters (and best speakers): Dr. Walter Kaye, of UC-San Diego, and Dr. Daniel LeGrange of University of Chicago, co-author of Help Your Teenager Beat an Eating Disorder. Yours truly will also speak.

The conference will be held at the Bethesda Marriott in Bethesda, Maryland. More details to come--stay tuned!

Sneak peek: Prologue

Hello all,

I appreciate very much the community that has developed around this blog (and others) over the last few years. Which is why I'm asking if you will do me a favor and read the prologue of the book I'm working on, tentatively called THE DEMON IN THE BAKERY. It's a family memoir about my daughter Kitty's anorexia and recovery.

Warning: This prologue may be triggering for those who are actively eating-disordered or in recovery, so please, skip it.

The rest of you--I'd value your honest reactions and feedback.

Thanks.



PROLOGUE: THE DEMON IN THE BAKERY

Close your eyes. Imagine that you’re standing in a bakery. Not just any bakery—the best bakery in Paris, its windows fogged, crowded with people who jostle for space in front of its long glass cases. The room is fragrant and you can’t take your eyes off the rows of cinnamon rolls and croissants, iced petits fours, flaky napoleons and elephant ears. Every counter holds at least one basket of crusty baguettes, still warm from the oven.
And you’re hungry. In fact, you’re starving. Hunger is a tornado whirling in your chest, a bottomless vortex at your core. Hunger is a tiger sharpening its claws on your tender insides. You stand in front of the glass cases, trying to swallow, but your throat is dry and your stomach clenches and contracts.
You want more than anything to lick the side of an éclair, swirl the custard and chocolate against your tongue. You dream about biting off the end of a cruller, feeling the give of the spongy dough, the brief molecular friction of the glaze against your teeth, flooding your mouth with sweetness. The woman beside you reaches into a white paper bag, pulls out a hunk of sourdough roll. You see the little puff of steam that flares from its soft center. She pops it into her mouth and chews and you chew along with her. You can almost taste the bread she’s eating. Almost.
But you can’t, not really, because how long has it been since you’ve tasted bread? A month? A year? An eternity. And though your stomach grinds against your backbone and your cheeks are hollow, though the tiger flays your belly, you can’t eat. You want to, you have to, but your fear is greater than your hunger. Because when you do—when you choke down a spoonful of plain yogurt, five pretzel sticks, a grape—that’s when the voice in your head starts up, a whisper, a cajoling sigh: You don’t need to eat, you’re strong, so strong. That’s right. Good girl.
Soon the whisper is a hiss filling the center of your head: You don’t deserve to eat. You’re weak, unworthy. You are disgusting. You don’t deserve to live. You, you, you. The voice is a drumbeat, a howl, a knife sunk in your gut, twisting. It knows what you’re thinking. It knows everything you do. It has always been inside you and it always will be. The more you try to block it out, the louder it becomes, until it’s screaming in your ear: You’re fat. You’re a fat pig. You make everyone sick. No one loves you and no one ever will. You don’t deserve to be loved. You’ve sinned and now you must be punished.
So you don’t eat, though food is all you think about. Though all day long, wherever you are—doing homework, sitting with friends, trying to sleep—part of you is standing in the bakery, mesmerized with hunger and with fear, the voice growling and rumbling. You have to stand there, your insides in shreds, empty of everything but your own longing. There will be no bread for you, no warm, buttery pastries. There’s only the pitiless voice inside your head, high-pitched, insistent, insidious. There’s only you, more alone than you’ve ever been. You, growing smaller and frailer. You, with nowhere else to go.
The voice is part of you now, your friend and your tormentor. You can’t fight it and you don’t want to. You’re not so strong, after all. You can’t take it and you can’t get away. You don’t deserve to live. You want to die.
This is what it feels like to have anorexia.

* * *

I’ve never had anorexia, but I’ve lived with it. I’ve observed it closely in someone I love: my oldest daughter, Kitty, who was 14 when she got sick. I watched as the happy, affectionate girl I knew became furious and irrational, obsessed with food but unable to eat. I saw her writhe in terror, heard her beg my husband and me for help and then, in the same breath, shriek that we were trying to poison her, to make her fat, to kill her. I heard a voice I did not recognize come out of her mouth, saw her gaunt face changed beyond knowing. I held her in my arms and felt the arc of every rib, counted the bones in her elbows, saw her breastbone press out through the paper-thin skin of her chest. I felt her body shake and knew that whatever comfort I offered it wasn’t enough, it was nothing in the face of the thing that was stripping the flesh from her bones and the light from her eyes.
I had no idea anorexia was like that.
Before Kitty got sick, I thought eating disorders happened to other people’s children. Not to my daughter, who was savvy and wise, strong and funny, the kind of kid who picked her way through the pitfalls of toxic middle-school friendships. She did fit the profile: she was a perfectionist, fastidious about how she looked and dressed. She was hard on people sometimes, especially herself. She was athletic, a gymnast, traveling around the Midwest for meets; her favorite event was the balance beam—fitting, I thought, for a child who so gracefully walked the line between childhood and adolescence.
But she would never have an eating disorder. She was way too smart for that.
Before my daughter got sick, I thought kids with anorexia or bulimia wanted attention, that they were screwed up and tuned out, bored or acting up or self-destructive. But my daughter was none of those things. She seemed cheerful and well adjusted; she had friends, interests, a passion for new experiences. She wrote her sixth-grade research paper on eating disorders. She knew the dangers. She would never choose to have anorexia. She was safe.
I was wrong about many things, but I was right about that one thing: Kitty didn’t choose anorexia. Anorexia chose her. And it nearly killed her.
At Kitty’s lowest weight, her heart beat dangerously slowly; it could have stopped at any time. Between 10 and 20 percent of people with anorexia die from heart attacks, other complications, and suicide; the disease has the highest mortality rate of any mental illness. Or Kitty could have lost her life in a different way, lost it to the rollercoaster of relapse and recovery, inpatient and outpatient that eats up, on average, five to seven years. Or a lifetime: only half of all anorexics recover in the end. The other half endure lives of dysfunction and despair. Friends and families give up on them. Doctors dread treating them. They’re left to stand in the bakery with the voice ringing in their ears, alone in every way that matters.
Kitty didn’t choose anorexia because no one chooses anorexia, or bulimia, or any other eating disorder. Intelligence is no protection; many of the young women (and, increasingly, men) who develop anorexia are bright and curious and tuned in. Families are no protection, either, because anorexia strikes children from happy families and difficult ones, repressed families and families who talk ad nauseam about feelings. The families of anorexics do share certain traits, though: A history of eating disorders, or anxiety, or obsessive-compulsive disorder. Or all of the above.
I’ve never had anorexia, but I know it well. I see it on the street, in the gaunt and sunken face, the bony chest, the spindly upper arms of an emaciated woman. I’ve come to recognize the flat look of despair, the hopelessness that follows, inevitably, from years of starvation. I think: That could have been my daughter. It wasn’t. It’s not. If I have anything to say about it, it won’t be.
This is the story of our family’s struggle. Kitty was diagnosed with anorexia in June 2005. In August of that year we began family-based treatment (FBT), also known as the Maudsley approach, to help her recover. That was the start of the hardest year of our lives and, especially, Kitty’s. That year, I learned just how brave my daughter is. Five or six times a day, she sat at the table and faced down panic and guilt, terror and delusions and physical pain, and kept going. And she emerged on the other side. After months of being lost, she came back to us and to herself, and the world took on color and sound and meaning once more.
So this book is for Kitty, and for all the children and teenagers and adults who have struggled or continue to struggle with an eating disorder: for your courage, your strength, your capacity to not just endure but overcome. I honor you with every word.

10 reasons why BMI is bogus

I love, love, love this piece from NPR on the top 10 (suggesting there are more than 10) reasons why BMI is a bogus measurement. My favorite:

The person who dreamed up the BMI said explicitly that it could not and should not be used to indicate the level of fatness in an individual.

Go read the rest for yourself.

Hey kids!

Want to develop a lifelong obsession with eating? How about an eating disorder? Or at the very least years of self-loathing toward your body? Have we got an idea for you! Start writing down everything you eat. That's right--every single bite you eat goes into this handy-dandy food journal that the folks at the Washington Post think you should keep.

Start now! Before you know it, you'll be on your way to a lifetime of unhappiness!

Grrrrr.

Listen in . . .

. . . to a fabulous radio show hosted by Susan Barnett of 51%, on body image, dieting, and anorexia. Barnett held a roundtable with four contributors from Feed Me, and then graciously gave me some airtime for a commentary as well. Good stuff.

Offline

I can't tell you how much I appreciate everyone who reads and comments on this blog. It means a lot to me to have the kind of thoughtful, intelligent discussions we do here with all of you.

For the next month or so, though, I'll be offline at a writing retreat. I hope to emerge refreshed and mostly through done writing my next book, BRAVE GIRL EATING.

Happy June!

Has your family been denied insurance coverage for an eating disorder?

I got a call this morning from a staffer at Good Morning America, looking for families to profile and potentially help with insurance coverage. If you're interested please get in touch ASAP.

Interview on True/Slant

Katie Drummond is an interesting young Canadian writer living in NYC and writing for a site called True/Slant. She interviewed me last week for the site, and here's a link to the results of that chat. It's always good to see eating disorders covered intelligently rather than in the Madonna/whore way of most media outlets, where people are either "accused" of having anorexia or ridiculed for being fat because they're wearing size 2 jeans.

Knitting and EDs

I have to admit my eyebrows went up when I first read about this study, which looked at whether the act of knitting could help people recovering from eating disorders. There are a lot of wacky, unproven, and frankly ridiculous "therapies" out there for eating disorders, many of which are rubbish.

But this one actually makes sense. Researchers from the University of British Columbia, Oxford University, and the Beau Cote Centre for Eating Disorders looked at whether the repetitive act of knitting could help with the inevitable anxiety and perseveration that comes along with the recovery process. While their study sample was small--38 women on an ED ward in a hospital--the results suggest that knitting did in fact have something of a calming and even therapeutic effect.

I can understand the principle: For me, washing dishes or weeding provides a similar effect. Human beings are hard-wired to work with our hands. And repetitive work like knitting can facilitate a zenlike meditation state that can be very soothing.

I like the fact that the researchers aren't claiming that knitting helps people recover from EDs. They point out instead the secondary but still important component of anxiety management. And I know not only from my own experience but also from Ancel Keys' Minnesota Starvation Study that anxiety is a major biological component of re-feeding and recovery.

And if knitting helps with anxiety, I'm sure there are other activities that do the same, that help break the cycle of obsessive thinking that comes along with EDs. Maybe crocheting? Quilting? Fiber arts as ED recovery corollaries? I love it.

Families and eating disorders

This story in the Gloucester Daily Times makes me see red. Literally. For its seemingly complete ignorance of the genetics of not just eating disorders but also personality traits like perfectionism, ambition, etc. The story reads as if whenever something goes wrong it's got to be the family's fault.

We know that it just isn't this simple. Fellow blogger Carrie Arnold summed it up wonderfully in this post. We also know that the blam-and-shame game undercuts families, who are often the best (or only real) resource for someone with an eating disorder.

So knock it off, will you? You're not helping. In fact, you're hurting families and sufferers alike. Do some reading. Do some thinking for a change. Then try your hand at some responsible journalism.

They don't even know they're doing it

Like most smallish local newspapers these days, the one in my town picks up a lot of copy from various sources. I'm not a fan of such content recycling, though I understand why it's done.

This item is the kind of thing I mean: a list that ran in a section called The Daily Dose, under a headline reading "Indulge, But Not Too Much." The intro copy reads "Almost everyone needs to indulge once in a while, so why not today, Memorial Day? Here are some ways to limit the damage, nutritionists say:"

Then follows a list of seven tips. Here's number 1 (the quotes are from the original):

Keep it occasional. There's nothing wrong with a little "cheating." Whether it's once a day or once a week depends on your weight, health, overall diet and activity level.

Can I tell you how many ways from here to next week this pisses me off? For starters, the assumption that everyone who reads this is on a diet. And not only are they on a diet, they're always on a diet. Hence the word cheating.

Wake up, people. Diets don't work. You know it, I know it, and researchers at UCLA said so several years ago, so it must be true. Yet this inane little piece assumes that everyone is continually on a diet. Or should be.

It's the assumption that gets me: the idea that any "indulgence" constitutes "cheating," that your entire life is supposed to be spent restricting what you eat, counting calories and fat grams. This assumption underlies 95 percent of the ongoing cultural conversation. It's so insidious we don't even name it, much less question it.

And check out the infantilizing language around this: We indulge like naughty children. We cheat like even naughtier children. When we're not being good, we're being bad. And like naughty children, we must be punished for our transgressions--in this case, by threats of the "damage" we're causing ourselves, and with warnings about how being fat will kill us.

I hated this kind of thing when I was 5. I damn well hate it now.

We don't hear much about findings like this one, which show that overweight heart attack survivors outlive thin ones, including those who follow the doctor's orders and lose weight after a heart attack.

My point is that by now, the bias against fat in every form is so widespread, so widely accepted, that to question it is the equivalent of throwing a rock through the neighbor's window: being a naughty child par excellence.

I wish the editors at my local paper had thought about this item before they plugged it into the hole on the features page*, but I really can't blame them. In 21st-century America, it's far worse to be fat than to be unfaithful to your spouse, to bilk your investors, to not give to charity. Several years ago, researcher Abigail Saguy coined the term moral panic to describe the way we talk and think about being fat in this society. I would add "unthinking, unquestioning moral panic." As items like this underscore all too well.


*In many ways, it doesn't even make sense. The list goes on to suggest that you "eat the real stuff" like ice cream (though only a half cup! Never more than that!) and "mix salt with fat" by adding peanut butter to your pretzels, but ends with the admonition, "Pretzels and baked potato chips are examples of tasty snacks without artery-clogging trans fats." Hello, how do you think we got to where we are now? It wasn't until the low-fat craze of the 1980s that Americans' weight began to rise.

Eight-year-olds

This story in The Sun (admittedly not my typical reading) uses sensationalism and inflated language to hype a story that in itself is disturbing enough: The fact that in the U.K. in the last year, 44 girls ages eight and under were admitted to hospitals with anorexia or bulimia.

Think about that. Eight-year-olds have new front teeth. They might wear their hair in braids and play on a soccer (football to you across the pond) team. They're learning to spell and to multiply. They might have a best friend, someone they giggle with at lunch or on the schoolbus. They might have a favorite doll. They might love to scrapbook or draw.

Now think about a child that age in the hospital with anorexia or bulimia.

And now think about why a newspaper might report this story with this headline:

"Anorexia in girls aged 8 soars 25 per cent"

The second paragraph comments, "Shocking figures showed a huge rise in anorexia and bulimia among young girls over the last five years."

The journalist in me wants you to think about the facts: In 2003-04, 35 girls under the age of 8 were admitted to hospitals for EDs. So we're talking about a jump of 9 girls--hardly a "shocking" figure.

The advocate and mother in me wants you to think about the fact that even one girl with anorexia or bulimia is a tragedy, whether she's 8 or 18.

OT: Need a laugh?

Editor types will especially love the headlines here, on a blog called The Blood-Red Pencil. Today's installment: headlines that should never have been written.

In the apparently imitable style of Wendy McClure of Candyboots, the editors have assembled a glorious collage of headlines from the dark side. My favorite--and it's so hard to pick just one!--is Include Your Children when Baking Cookies. The commentary: Certainly important in some recipes—"Northern Witch Missionary Lip Stew" comes to mind—but a rather expensive ingredient, no?

Yes indeed.

Do you live in Australia? If so, read on . . .

Eating disorders are a huge problem Down Under. And now the Australian government is talking about a project that takes my breath away with its foresight and thoughtfulness. The Australian minister for youth, Kate Ellis, wants to, as she says, "develop a strategic national approach to tackle negative body image in a coordinated, targeted and effective way."

Ellis has created an online consultation on body image, with an eye toward creating a "code of conduct" for media, advertisers, and the fashion industry. Wow. I think Kate Ellis is my new favorite government official on any continent.

If you live in Australia, you can help by taking this online survey. (La-Di-Da over at Fatomatic suggested that anyone could take the survey, but I tried this morning, and you can't complete the survey unless you live in an Australian state. Or at least say you do.)

I look forward to following this story as it develops. Frankly, just to have someone like Ellis ask the questions is very heartening no matter what happens next.

Obesity and suicide

The lede of this story says it all:

As if the many physical health concerns associated with the obesity epidemic weren't worrisome enough, new research shines a light on an alarming mental health connection: Teenagers who are overweight are at higher risk of attempting suicide. Even teens who merely believe themselves overweight -- but actually are not -- are more predisposed to suicidal behavior, the researchers found.

As if reading stories like this weren't enough of a health risk. . . .

Why the shock, ladies and gentlemen? By now we know that the stigma associated with being fat in this society has devastating consequences for your health, mental and physical.

We know that hormonal shifts, poor impulse control, and other factors make teens especially susceptible to suicide.

Put the two together, and what do you get?

Shocking, no?

Say it after me: I-Am-a-Shill

My first reaction to this story on The Daily Beast was to look for the small print labeling it an ad. Sadly, it's not an ad but real-live editorial content. Sort of.

Written by one Dr. Susan Roberts, a professor of nutrition and professor of psychiatry at Tufts University (who also just happens to be the author of a brand-new! fabulous! dieting book), this piece purports to tell you why crash dieting is just as effective as "more gradual weight-loss" regimens.

Dr. Roberts left out one tiny factoid here: No diets are effective in the long-term.

So yeah, Dr. Roberts, maybe crash dieting is "just as effective" as Weight Watchers or Jenny Craig. But how could you have neglected to mention the fact that more than 95 percent of dieters not only gain back the weight they lost but they gain back more? Have you not seen the UCLA study showing that diets don't work? Maybe you think your new diet is better than every other diet that's ever been marketed. Or maybe you just don't care, so long as you make a buck here. Or a lot of bucks.

I expect better than this from a professor of psychiatry. And even, frankly, from Tina Brown's website. Brown used to be editor of The New Yorker, for god's sake, a magazine renowned for its fact-checking and reporting excellence.

How the mighty have fallen.

Watch. This. Please.

Do lesbians have better body image?

That's the intriguing suggestion made by this study, published in the March issue of the Journal of Women's Health (which is currently online free in honor of Women's Health Month). This study of young Australian women showed that lesbians had better body image than either bisexual or mainly heterosexual women. They were less dissatisfied with their weight and shape (notice the phrasing here: "less dissatisfied" as opposed to "happy with"), and less likely to engage in what researchers call "unhealthy weight control behaviors"--i.e., smoking, using laxatives, weight cycling, and skipping meals.

I could speculate as to what's behind this--couldn't we all?--but I'd love to know more. "Understanding why lesbians have a healthier body image would also provide insights into how to improve the body image of other groups," write the study's authors. Indeed.

Fat-friendly doctors

I'm writing a magazine piece right now on "women's diseases"-the disorders (often autoimmune) that have historically been pooh-poohed by doctors. I'm talking about diseases like chronic fatigue syndrome, lupus, MS, fibromyalgia, and PCOS. As part of my research, I've talked to many women with these diseases, especially PCOS, or polycystic ovarian syndrome. One of the telltale characteristics of a woman with PCOS is having very high levels of insulin, which wreaks all sorts of havoc on the body. And which, oh yes, makes you gain weight.

One of the women I interviewed talked about gaining 125 pounds in less than a year, without changing her diet or exercise habits--and then being told by a doctor that she had to "get your eating under control!"

Of course, you don't have to have PCOS or another illness to have had a run-in with fatphobic doctors. Many of the stories here speak to the same issues.

So for anyone who's ever had to deal with a doctor who just doesn't get it, here's a link to a fabulous list of fat-friendly health professionals around the world.

The site is maintained by one Stef Maruch. Thanks, Stef. You're doing us all a big favor.

Why the food and exercise police are unsuccessful

The human body is an amazing thing. Amazing! As every dieter knows, if you cut back on its fuel one day, you'll feel hungrier the next as your body tries to compensate. Turns out the same model applies when it comes to physical activity. If you give kids more gym time, more time spent running around, they become less active when they're not in school.

At least, that what a new study done in the Netherlands shows. The study results, presented last week at the European Congress on Obesity, demonstrated yet again why trying to manipulate kids' eating habits and weight through "interventions" is ineffective. Researchers looked at kids from three schools, who got 9.2, 2.4, or 1.7 hours of scheduled phys ed time in a school week, and found that kids' activity levels averaged out to be exactly the same no matter how much gym they got in school. Those who didn't get much PE time at school became more active at home, while those who got a lot of PE in school did less at home.

"We believe the range of activity among children, from the slothful to the hyperactive, reflects not the range in environmental opportunities, but the range of individual activity set-points in the brains of children," said Alissa Frémaux, a biostatistician (I didn't even know there was such a thing! very cool) who analyzed the study.

I think more PE time in schools is a great thing, especially when there are big gaps in the socioeconomic status of kids. While some kids get carted around to ballet and soccer, too many kids have no opportunities outside of school to move, be active, exercise, and have physical fun. So I'm all for piling it on at school.

Just don't expect more gym time to equal thinner children. And don't think that lowering the fat content of school lunches will translate into thinner kids, either.*



*I am deliberately leaving aside the notion of whether these are desirable outcomes. The plain truth is that they're not achievable. Constant readers know what I think anyway.


**Thanks, as usual, to Jane for pointing me toward this research.

Guest post: One woman's story

This moving guest post, written by a 36-year-old reader, expresses vividly one young woman's slide into disordered eating and then an eating disorder. Her story involves a family that unwittingly triggered her ED. For every family like this, there are many others who do not value their children's thinness above all, and who don't contribute to pathology. So while I don't agree with her conclusion that "It's hard to have an eating disorder without the support of family and friends," I know from my own family's experience just how much validation and--as she points out--admiration comes your way just for being thin. Many of us don't realize we're validating pathological behaviors. I hope this will be a wake-up call for some.

A few months before my younger sister's wedding, she jokingly challenged my older sister and I to lose weight. My younger sister is very petite. She has always been very skinny. My parents (especially my mother) adore her.

At the time I was going through a spiritual crisis and felt a loss of control. I decided to go on a calorie-counting diet. I felt I couldn't control other things in my life. But I COULD control what I ate, and I could control how much I weighed.

It started fairly healthy. I bought a food scale and allowed myself the minimum amount of calories that experts recommend. My feeling is I'd get to my goal weight for the wedding, and when that was done I'd go off the diet.

I started off this diet as someone who has never really been overweight. I just wasn't thin like my sister. My weight was within the recommended ranges.

By the time the wedding came around I was thin. My parents were so proud. My dad even made comments in private about how he thought my beauty overshadowed the bride's. I received so much attention. I felt so proud. One of my parent's friend's kept praising me about my amazing willpower. One aunt did express concern. She said I looked too thin. I remember loving this attention.

At the wedding, I ate...a LOT. After weighing myself I realized that I couldn't just go off the diet. All the weight would come back. I'd have to stay on the diet for life. I told myself that was fine. I'd go on breaks sometimes and eat what I want.

My life and happiness became centered on these breaks which usually occurred on holidays and trips. Food became the center of my life. Nothing else could really excite me or make me happy. I'd spend hours and hours looking at restaurant and food websites.

Meanwhile, I kept wanting to lose more weight. Soon I came to the point where my weight at my sister's wedding seemed fat to me.

I don't think I had a body image distortion problem. I knew I was thin. I didn't look in the mirror and see a fat person. I saw a beautifully thin person. (Now though I look back at these photos and I AM thinner than I imagined).

The wedding had been in May. By Thanksgiving, I was underweight. My birthday was around this time and has a gift my mom took me shopping. She was so proud of my weight loss--bought me clothes to show it off.

At Thanksgiving, I opened my presents. Everyone wanted me to try the clothes on. Even though I was underweight, they had bought me clothes that were still tight. I could wear them, but I knew if I gained a little weight, I could no longer wear them.

I wasn't a teenager during all this. I was a mother with a four year old son and an aunt with two nieces. I think a part of me knew I had a problem, but another part of me denied that. I remember seeing someone horribly thin jogging and thinking. I am NOT like her. I'm okay.

I didn't want to die and leave my child an orphan. I told myself I was fine. I told myself there was a difference between eating disorders and strict healthy dieting. But I think a small part of me knew I was fooling myself. Maybe? I'm actually not sure.

The dieting continued. The numbers on the scale got lower.

During the beginning of the dieting, I had begun walking. I'd put my son in a stroller and do a long walk everyday. (or almost every day) My parents were very impressed with this. I received a lot of praise. Eventually, I bought a pedometer and made outrageous rules about how much I'd have to walk each day. I'd do this by never sitting down. I'd just walk and walk around the house--constantly. I remember having guests over and wanting them to leave because I was too embarrassed to obsessively walk in front of them. I felt they were intruding on my walking time.

I made rules for myself such as you can't eat another piece of food until you walk a certain amount of steps.

I started wanting to take more breaks from the diet. I made rules that if I was at a certain weight I could do this. I started drinking herbal laxative teas in hopes that this would make me lose those extra pounds. I didn't have much luck. My system was so slow at that point. I stopped having daily bowel movements.

About a year and a half after it all started, I received comments on my Livejournal blog from an anonymous stranger. An LJ friend had recovered from an eating disorder and was disturbed by my constant public recording of my weight. She approached another ED friend and they gave me a mini-intervention. She said it seemed like I had an eating disorder. She talked about my issues of control. And she scolded me for recording my weight. She said all this might be a trigger for someone.

I was furious and disgusted with her.

A few months later my sister (the thin one) approached me about the eating disorder. I actually don't remember my response. I can't remember if I denied it, or if by this time I knew I had a problem.

Eventually though I got over it.

I put away the scale (food and body). I stopped wearing a pedometer.

I stopped dieting.

I was disturbed to find myself quickly returning to my old weight, but I have grown to be mostly okay with it.

I have taken the scale back out, but I never weigh myself more than once a day. I also NEVER punish or reward myself based on my weight. I accept the number and realize there are so many things about myself that are much more important.

For the most part, I'm happy with myself.

I'm no longer obsessed with food. I like to eat, but it's definitely not the center of my happiness. My husband is a bit of a foodie and I actually get bored now when he starts going on and on about food.

I have had setbacks. My husband's friend went on a diet where you fast every other day. I read about it, decided it was safe, and tried it too. I lost a few pounds, but found myself obsessing about food again. I decided this was unhealthy and quit after a few weeks.

Every so often I have days/nights where my self-esteem sinks very low...usually caused by some interpersonal conflict. I get very depressed and feel worthless. I make a vow that in the morning I'm going to go back to strict dieting. I think this is less about being thin though and more about feeling self-destructive and needing a sense of control.

Fortunately, in the morning I usually come to my senses and eat normally.

When I first came to terms with my eating disorder--around the spring of 2007, I emailed my family about all of it. I told them about how I now know I had an eating disorder and I'm going to stop the negative behaviors. I expected to get sympathy, concern, and kudos for wanting to overcome my problem. That is not what happened. One of my brother-in-laws didn't believe I had a disorder and told me that. He told me I was just very dedicated. That's all it was. I put my mind to something... a goal and I achieve it. During the ED times, he'd frequently ask me how much weight I had lost. He was so impressed and gave me a lot of attention over this.

My dad showed no concern or regret for what happened to me. He merely scolded me for confessing that I had not gone to certain family outings because I had wanted to avoid food. (in the beginning I was one of those who would happily watch other people eat--even make huge desserts for others, while I ate a piece of fruit or nothing. But later this became harder for me and I sometimes avoided social events so I wouldn't have to jealously watch other people eat). Family togetherness is very important to my dad and he was horrified that I'd choose not to be with family.

After getting the email, I had shocking encounters with my family. Although I told them I was no longer dieting, they still sometimes acted as if I were At one time, we had some kind of celebration that involved cake. My BIL said not to worry. He had fruit for me! Even after I told them my problem and that I'm not on a diet any longer, he went out to get a special meal for me. I was horrified and hurt. I felt they were trying to push me back to the diet.

Another time, we were all about to have cake. My mother turned to me and said something like "Are you going to have some, or are you dieting?"

I was so disgusted that they'd say these things knowing I had an eating disorder. I would think they'd be HAPPY to see me eating.

For the past two years, I have resented their reaction...but I resent a lot about my family. For some reason, the past few weeks I've been thinking about it and wondering why they didn't give me more support.

My mom is on the Jenny Craig diet. I saw her eating a JC cake, and started thinking maybe I should go back to dieting. Maybe this one would work for me because it doesn't involve counting. I know it would be dangerous for me to do any diet where numbers are involved.

I brought it up to her in the car. I asked if she thought it was an okay diet for someone who has an eating disorder. I confess that I think I wanted to see her reaction to the eating disorder thing. After that email, we had never discussed the issue. I guess I wanted to see what she thought.

Well, I found out. She told me she didn't think I had an eating disorder. She says almost everyone goes through yo-yo dieting and if I had an eating disorder probably most women do. She asked...isn't it just as bad to keep eating and gaining weight. Isn't that a disorder?

I told her I'd rather be a few pounds overweight than have an eating disorder again.

I basically then learned she feels to have an eating disorder you have to be in the hospital close to death. She feels because I was never officially diagnosed by a doctor, and was able to gain the weight back on my own, I never had a problem in the first place. I think to her what I did back then was GOOD. The bad thing I'm doing is now--not being thin anymore.

It is really hard to struggle with something, overcome it the best that you can, and then be told you never had a problem in the first place.

I think eating disorders are unique in that instead of getting sympathy and concern....you get admiration.

When I got home from being with my mother, I cried on my husband's shoulder. We talked about the past and how neither of us knew I had a problem back then. I think he feels some guilt. He saw some old pictures of me and realized how thin I had been. He hadn't realize it back then. Then he told me about his friend (the same one who went on the fasting diet). He told me he's concerned with her because she has stopped eating. She is now a very low clothes size. She's in an emotionally abusive relationship. Her boyfriend said something like "I usually date women who are thinner than you." My husband's friend has major relationship and self-esteem issues. She obviously has serious problems. But despite knowing all this, there's this small part of me that's jealous of her. There's a small part of me that admires her.

Anyway, that's my story.

From my experience, I think family members play a big role in eating disorders. I may be going too far in saying this, but my motto is "It's hard to have an eating disorder without the support of family and friends."

I can imagine it's worse for teenagers who actually live with parents. But as an adult, I have a very troubling co-dependent relationship with my parents. They live close by and we see them frequently.

If I had advice for family and friends of people who are dieting, it would be this:

1. Know the signs of an eating disorder and know when your relative/friend is going too far.
2. Do NOT make big deals about someone's weight loss. Do not give them extra attention over this. Find other things to praise them about.
3. Do not point out that a dieting person is eating. Don't say things like "Oh, I can't believe you're eating that" or "Are you off your diet?"
4. Do not praise them for their willpower. Don't praise them for their excessive exercising or their ability to eat an apple while everyone else eats a huge sundae.
5. Do not take them shopping to award them for their weight loss. If parents do this, they should at least buy things that are a little big so the person can grow into them. Do not buy things as small as possible--giving person idea they MUST stay at this weight.

I know ultimately I'm responsible for my own health. It was my fault I had these problems and it's up to me not to return to them. But I do think certain family situations contribute to these problems. For me, it was having a family that highly values thinness, fashion, and beauty.

As a teenager and young adult, I wrote multiple novels and screenplays. My parents gave me much more attention and praise for the weight loss.

Having a skinny sibling who is clearly the favorite also contributed to that. I felt if I got down to her weight, they'd love me like they love her. And in some ways, it did work.

You know ....I think about what contributed to my recovery. I want to say it was the Livejournal visitor or my sister. But you know who probably made me come to my senses. JK Rowling. On her website, (http://www.jkrowling.com/textonly/en/extrastuff_view.cfm?id=22) she has a great essay about eating disorders. I'm a huge fan of hers and I think reading that helped me realize I was doing a bad thing not just to myself but to my son and nieces.

I started thinking what kind of message am I sending to these two little girls. They already have one very skinny aunt. What if they have two? And what if one of them is constantly dieting and exercising?

When you have an eating disorder, you're not only hurting yourself. You're hurting anyone who might see you as a role model. It's great to be a role model, but be one for something that's great. Don't be one for self-destructive behavior.

What will it take?

I write this post in sorrow and distress, after reading this story about a 57-year-old woman in the U.K. who died after 40 years of being anorexic.

It's a tragedy when anyone dies from an eating disorder, especially someone like this woman who, according to the article, died friendless, without family, alone in the world.

But the overarching tragedy here is the profound misunderstanding of anorexia expressed by the medical establishment here. While her doctor obviously cared enough about her to be checking up on her at home (he's the one who spotted her lying on the floor), he clearly doesn't get some of the most basic facts about anorexia.

Here's a quote from the story:

Discussions of her case with psychiatrists and other experts in the past had all concluded that any effort to force her to eat would only make matters worse.

"I believe that she understood the nature of her illness and its perils," Dr Knight told the inquest. "She seemed to have a very firm understanding of her condition. The anorexia was a long-term chronic condition which would not be significantly modified – she was set in her ways."

This makes me want to cry. Then scream. Then change something.

"Any effort to force her to eat would only make matters worse." Let's say a person was delusional about the act of breathing. Breathing makes you sick, they say, and they spend as much time as possible holding their breath. They have to breathe sometimes, but they do it as little as possible. Now imagine a doctor saying "Any effort to force her to breathe would only make matters worse."

I didn't think so.

When someone has been chronically ill with anorexia, their delusions are, as the doctor goes on to say, "set in their ways." But that doesn't make those delusions true. Efforts to force this poor woman to eat would have caused enormous upheaval and distress for her and likely everyone around her. That's the nature of the illness, especially when it's become chronic. (Which is why I'm a big proponent of the Maudsley approach; if you can cure anorexia while someone is still young, they often don't go on to become chronically ill. And that's why it makes me so angry when doctors still take this line with teens who are sick; don't they understand what's at stake? But I digress.)

One of the most well respected ED docs/researchers in the world, Dan le Grange, once told me that there is something about anorexia that seems to affect the people around the anorexic as well as the ill person herself. This story is a heart-breakingly good example of that kind of distorted thinking legitimized. Why is it OK for someone under a delusion like anorexia to starve herself to death? Could it be because of our messed-up ideas about body image and weight?

Here's a later quote from the doctor: "Her body image was such that she thought that she looked the right way even though to everybody else she was very, very thin."

One of the hallmarks of anorexia is an inability to see your physical body realistically. People with anorexia literally look at themselves and see oozing fat even when they're emaciated. This is one of the profound neurological distortions that we know is part of the disease even if we can't understand it yet.

So yes, this woman "liked" the way she looked. But she was in no position to "like" anything about her body, because her self perceptions were profoundly and utterly distorted.

So here's what I want you to take away from today's post:
1. People with anorexia cannot choose to get well. They need at the very least support and help from others. Often they need others to begin the recovery process for them, and stick with it for a long time, until their thinking and ideation is restored to normal.

2. There's nothing sacred about anorexia. It's a terrible, tragic illness. There is nothing glamorous about it.

3. As a society we have a responsibility to help people with this disease recover. Which doesn't include letting someone starve herself for 40 years, only to die, alone and friendless and emaciated, on her bedroom floor.

To this woman's doctor in particular I say: You meant well but you failed. And guess what? Good intentions don't count for shit. What will you do differently with your next anorexic patient?

To the rest of you, I ask that you think about this woman the next time you talk to a friend with anorexia or bulimia. And see if there's anything at all you can do to help your friend recover.