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.

Happy No Diet Day!

Ways to celebrate:

1. Take the I-Love-My-Body pledge. Better yet, print out a few copies and leave it in public places--on subway and bus seats, tacked to bulletin boards, tucked into bathroom mirrors. (I'm working on finding a way to upload the beautiful graphic version designed by Mary Brown and will post that shortly. Blogger doesn't like my files, apparently.)

2. Eat a cupcake. Better yet, bake a dozen and hand them around.

3. Buy your very own copy of Lessons From the Fat-o-Sphere by the inimitable Kate Harding and Marianne Kirby. (If you can get it from an independent bookstore, even better!)

What are YOU doing today? Send me your no-diet-day stories.

Dear Kirstie Alley,

You seem like an intelligent person; I've admired your acting skills over the years. You seem eloquent and tuned in, except on one subject: weight.

Interviews like this one make me cringe for you and with you, Kirstie. There you are on Oprah's show, being watched by millions, most of them women, many of them, like you, beating themselves up over failed diet. How can you not know by now that it's not a question of your failure? That it's not like "falling off the wagon," as Oprah put it, but rather a basic scientific fact: Diets don't work.

Don't take my word for it. The nice researchers at UCLA did a study two years ago that showed that more than 90 percent of diets don't work--in fact, that dieters wind up gaining back all the weight and then some. Just as you did. Just as so many of us have done.

You say you feel bad because you've inspired so many people and now have let them down. I say you have an opportunity right now to inspire people in a much more meaningful way than before--you and Oprah both. You are both smart, powerful women with some of the best resources in the world at your fingertips. If you can't make your bodies look the way you want, maybe the problem isn't you. Maybe your bodies aren't meant to be size 2s or 4s. Maybe you are both tall, strong, powerful women who are built the way you're built because of genetics.

Maybe the real story here is this: What will it take to make you acknowledge your power in the world and use it for good? What will it take to help you stop wasting your time and emotions on an impossible quest?

You want to inspire other women? Try learning to love and accept yourself for who you are. Now that would be inspiring.

--From a fan

Calorie counts in college dining halls

Over on the Academy of Eating Disorders listserv, there's been a discussion going about whether it's good (or even just OK) to post calorie counts for food served on campus. I've listened with interest, and a growing sense of frustration and horror, as both researchers and clinicians debate the pros and cons.

What most of them seem to be missing--or deliberately downplaying--is the damage these calorie listings can do, not just for people with eating disorders but for everyone. And especially women. About three-quarters of women say their eating is disordered in some way, and my personal experience (for myself and watching my friends and acquaintances) certainly bears this out.

It gets right up my nose to hear the sometimes pompous arguments made by academics and researchers on an issue like this. Statements like this one: "Awareness doesn't equal obsession." Um, maybe not if you're a 40-year-old male doctor who's never had an eating issue. If you're a woman in today's culture? I beg to differ. Many years ago when I "did" Weight Watchers I was aware that eating on the WW meal plan simply replaced one food issue with another. Instead of constant anxiety about how much and what I was eating and whether I was gaining or losing weight, I became a good little obsessive weigher of foods and follower of instructions. In nine months on the program I never deviated from it once. Not even for a bite. This was a testament not to my willpower or moral virtue but to the deep level of obsession that being hyper-aware of my calorie intake inspired in me.

I'm quite sure I'm not alone in this.

Which is why I was happy to see this article, written by a senior at Yale, arguing against listing calorie counts for food served on campus.

In theory, maybe "awareness" of calories isn't a bad thing. In reality, I can't see the upside.