Feed Me!

What do YOU stand for?

2012-01-29T15:01:00.003-06:00

Deepest thanks to the fabulous Marilyn Wann, who created the "I Stand for" project in response to Georgia's shameful Strong4Life campaign. I'm proud to be one of the many, many people who stand for something besides weight bigotry, shame, and stigma.

You can see the whole series on Marilyn's tumbler and facebook pages. They're a pretty inspiring bunch. If you'd like to participate, send your photo and "I Stand for" statement to Marilyn at marilyn@fatso.com.

This makes the Georgia campaign even more manipulative

2012-01-22T10:16:00.003-06:00

According to a story today in the Chattanooga Times Free Press, the heavy children shown in the state of Georgia's shaming, shameful Strong4Life campaign are child actors hired to pretend they have hypertension, no friends, and other negative qualities the ads associate with childhood obesity.

Because . . . they couldn't find any fat children with those conditions who were willing to model for their ads?

Maybe. Maybe not. Here I was worrying about how starring in an ad like this would affect a child like "Jaden" or "Maritza." It turns out there is no "Maritza," or rather, "Maritza" is actually a healthy 11-year-old girl named Chloe who does not have hypertension, or any major health issues.

So it turns out that not only is this so-called public health campaign manipulative and shaming, it's also a big lie. A big FAT lie.

Stop lying, Georgia. Really.

Dear "Starving Secrets"

2012-01-12T06:21:00.004-06:00

Editor's note: Today's guest post comes from 15-year-old Bridgette T. I'm impressed with this young woman's articulateness and determination and I think you will be too. And if you're not sure you agree with her, I suggest you google the show and click on "images."

*************

Dear Starving Secrets,
I am a fifteen year old girl recovering from anorexia. This is currently my tenth week in an outpatient program. I began treatment in the program after my initial evaluation there resulted in me being sent to the hospital. I was in the hospital for sixteen days, though I never restricted during any meals except for my first one. I had to drink at least one Ensure every night, as my heart rate dipped into the 20s when I was asleep.

I’m not asking to be on your show. I’m asking you to reconsider it.

The title was the first thing that shocked me: Starving Secrets? Really? They’re making a pro-ana show?! Huh…that’s going to be pretty hard to stay away from…

Then I saw a commercial for it: What in the world? People with anorexia are being documented? If I were just a normal person and I found out that there was a show about people who were anorexic, and all I knew about anorexia was that it made you skinny-of course I would watch the show, to learn how they do it! How do they drop that much weight? I understand that the show also shows the negatives of eating disorders, but I don’t think kids are really going to take that into account. A big thing with eating disorders is the whole “It couldn’t happen to me” thing. At treatment, people are told that by not eating they are risking going to the hospital. Half of us already have gone to the hospital. Though vitals are tanking and we know that people have died from this disease, it doesn’t make people eat. Because you simply don’t believe it could happen to you, that you could be that girl whose funeral is on the local news because she starved herself to death.

Though this show may help inform some people, it’s also going to trigger many. Is it really worth the risk?

Sincerely,
Bridgette

What's wrong with Georgia's childhood obesity campaign

2012-01-06T21:27:00.005-06:00

My Aunt Selma was a fat teenager. Like most fat kids, she was deeply ashamed of her body. She tried many times to lose weight, and eventually hit on two strategies: cigarettes and bulimia. She died in excruciating pain, in large part from the abuse she’d heaped on her body for many years. But she died—and lived—thin.

I think about Selma every time I hear about yet another new initiative to fight childhood obesity. The latest is Georgia’s “Strong 4 Life” campaign, which features black-and-white images and video clips of children talking about being fat. Several of the kids say they don’t like to go to school because they get picked on. One asks his mother dramatically, “Mom, why am I fat?”

The answer is implicit in the advice found on the campaign’s website: Eat less junk food and more fresh fruits and vegetables. Be physically active. Limit screen time. All great ideas, except that doing these things won’t necessarily make kids thinner. Over the last decade, dozens of school programs have used nutrition education, junk food bans, and farm-to-school projects to try to slim schoolkids. None have worked. They’re positive programs that support kids’ health. But they’re considered failures because they don’t reduce weight.

Like virtually every other effort to combat childhood obesity, the Georgia campaign suggests that obese kids and adults can get thin by making moderate lifestyle changes, a fact not borne out by research or experience. Rudolph Leibel, an obesity researcher at Columbia University, has demonstrated over and over how biology makes maintaining weight loss difficult to impossible for most people.

And like most such efforts, the Georgia campaign fails to take into account the connection between obesity and stress—specifically, the stress of being stigmatized over weight. When Jaden tells the camera he likes to play video games alone because other kids pick on him, the screen reads, “Being fat takes the fun out of being a kid.” The implication is clear: The problem is with Jaden. It is his fat, and the fact that he is fat, that make the other kids taunt him. The ad follows up with a taunt of its own: “Stop sugarcoating it, Georgia.”

Peter Muennig, M.D., of Columbia’s Mailman School of Public Health, researches the connections between weight and health. He believes stigma and weight bias are responsible for at least some, and possibly most, of the adverse health effects associated with obesity. In other words, it may not be weight itself that makes people sick, but rather the stress of being fat in a fatphobic society. Kortni Jones, a physician’s assistant in Michigan, looked at the relationship between weight stigma and health care in her master’s thesis, and found that messages of overt stigmatization from health-care providers translate to worse health care for people who are obese. Rebecca Puhl of Yale’s Rudd Center for Food Policy & Obesity has come to similar conclusions after doing a series of studies on how stigma affects obesity.

Clearly, shaming people about weight is not an effective public health strategy. So why are we still doing it? Why, for instance, is there nothing on the Georgia campaign website about educating kids not to tease each other over weight? Why do people who would never dream of telling a joke about blacks or Jews tell fat jokes without flinching?

Efforts like this one emphasize the idea that weight loss is a matter of personal responsibility, and they demonize fat children and teens in the name of helping them. How do kids feel when they see kids who look like them being targeted as not OK? They already know it’s bad to be fat; in one recent study, children as young as three showed a strong preference for thinness over fat, and made comments like “I hate her because she has a fat stomach” and “She’s fat and ugly.”

I have a better idea for a public health campaign, one that’s supported by research and experience. Let’s take the best ideas from campaigns like this one and frame them around health instead of weight. Instead of trying to make fat kids thin, the goal would be making all kids healthier.

We don’t fully understand why some people become obese and others don’t. But we do know that all of us, no matter how old, no matter how fat, benefit from eating well and getting exercise. We know that friends are good for our health and that bullying hurts the bully as well as the victim. We know that shame drives people like my Aunt Selma to self-destructive behaviors. In my campaign, the word obesity would never be mentioned. But the words health, respect, and compassion would be on every page.

You're invited

2011-12-29T11:31:00.003-06:00

to the next--and probably last one for a while--Maudsley Parents conference. This one is very exciting, because it's covering not just Family-Based Treatment but a broader spectrum of issues in child and adolescent eating disorders.

The one-day conference will bring together families, clinicians, and experts to talk about the current state of treatment in child and adolescent eating disorders and new directions for the future. It's being held in an absolutely gorgeous hotel, the Pearl River Hilton, in Pearl River, NY, about an hour outside of New York City.

Featured speakers include Debra Katzman, MD, on the current state of treatment for kids and teens with eating disorders; Rebecka Peebles, MD, on the medical side of treating kids and teens; Katharine Loeb, PhD, on the need for early intervention (and how best to achieve it); Evelyn Attia, MD, on the role of medication in treating eating disorders in kids and teens; and Daniel LeGrange, PhD, on working with families from both a therapist's and parent's point of view. Oh, and I'll be talking about the parents' perspective as well.

We've worked hard to keep the price reasonable, so families who are already financially stressed can attend. If you register before 12/31, the cost is $60; after 1/1 it's $75. We've reserved a block of rooms. For more information and to register, click here.

So please join us for what promises to be an educational and entertaining day! See you there.

What do you expect from the research journal Obesity?

2011-12-09T21:42:00.003-06:00

This is what you get, at least on the cover of the journal's November issue:

I don't know about you, but I think Santa looks kind of grim. Ill, even. Someone should tell him that physical activity and fitness are a lot more important than weight. He might want to read up on the fact that being heavier later in life isn't such a bad thing, that in fact weight loss later in life isn't a good idea. So long as he stays active, making and delivering all those gifts, he'll likely live to a ripe old age whatever his weight.

Someone should give that guy a cupcake.

Looking for . . .

2011-12-05T11:08:00.003-06:00

Greetings everyone!

I'm working on a story for the New York Times, and am looking to interview any of the following:

--> eating disorders therapists or clinicians with a history of eating disorders themselves
--> eating disorders patients who have been treated by therapists, nutritionists, etc. who have had a history of ED themselves

I'm looking to explore the pros and cons, so any and all feedback is welcome.

Please email me at hnbrown at syr dot edu if you'd like to chat or email. And please pass along the word.

Thanks!

Another entry in the annals of Bad Ideas in Eating Disorders

2011-11-04T17:05:00.002-05:00

is a soon-to-be-aired reality show called, I kid you not, "Starving Secrets with Tracey Gold.

The idea is that child actress-grown-up Tracey Gold, who nearly died from anorexia in her early 20s but is now married and recovered, will meet one-on-one with women suffering from eating disorders. As the show's early PR puts it, Gold will "work with women in the grips of anorexia or bulimia as she uses her own experience to reach them in ways no one else can."

Really? No one else but this particular former actress can help these women? I knew the state of treatment was bad, but not this bad.

And who the hell gave the show this title? It doesn't sound like it's designed to help. It sounds like viewers will be treated to pro-ana tips from Gold.

I'm sure that's not her intention . . . right? Someone reassure me? Because so far I'm unconvinced.

I'm not a fan of reality shows in general, especially when they purport to stage interventions or reveal long-held secrets in a very public forum designed to entertain other people. They can't help but be exploitative-that's their whole raison d'etre. But this one sounds particularly egregious.

Ugh.

Britney Spears, before and after Photoshopping

2011-11-01T16:22:00.002-05:00

If you're reading this blog, you probably know what I'd like to say about this. But I think I'll let the image speak for itself.

Come talk to me!

2011-10-04T07:40:00.002-05:00

Thanks to Maudsley Parents and the University of Chicago for hosting an evening with Dr. Daniel le Grange and myself at University of Chicago on October 20th. This is your chance to meet up with other families who may have dealt with eating disorders, to learn from them, and, most important, to not feel isolated or alone.

This event is free, thanks to the generous sponsorship of Maudsley Parents, but you must RSVP to reserve a place: RSVP@maudsleyparents.org.

I hope to see you there!

Upcoming events

2011-09-18T10:37:00.003-05:00

In honor of the paperback version of Brave Girl Eating, which was just released, I'm doing some events this fall, and I'd love to see you at any of them. Here's what's coming up:

Thursday, October 6: I'll be reading at Syracuse University's Nonfiction Reading Series. This should be an informal chance to hear excerpts of the book and talk. 3:30-5 p.m., 500 Hall of Languages, on the Syracuse University campus. Free!

Thursday, October 13th: I'll be reading from the book, along with Randy Cohen, who write "The Ethicist" column for the NY Times magazine for many years; poet Charles Martin; and others. 6 p.m. At Lubin House, 11 E. 61st St., NYC. Free!

Thursday, October 20: I'll be reading from the book, and facilitating a conversation with Dr. Daniel le Grange and families who have struggled with eating disorders. This will be an informal evening, with chances to connect and talk and ask questions. Sponsored by Maudsley Parents. 7 p.m. At the University of Chicago's Quad Club, 1155 E. 57th Street, Chicago, IL. FREE, but please RSVP to RSVP@maudsleyparents.org or or call Leah Boepple at 773-702-0789.

Hope to see you in Syracuse, New York or Chicago!

New Zealand Radio

2011-08-20T12:33:00.003-05:00

ran a nice interview about Brave Girl Eating. You can find it here. The lovely New Zealand accents don't hurt either! :)

Just in case you were confused about the nature of eating disorders . . .

2011-07-31T13:06:00.001-05:00

read this, which is circulating on Tumblr. My younger daughter sent it to me. Wise girl.

OT: Veterans and mental health

2011-07-09T07:54:00.004-05:00

Indulge me in a slight change of subject this morning, to the very real problem of health care for veterans. Specifically, mental health care.

It's well known that veterans who return from war struggle with a slew of mental health issues. And it's very well known that suicide is a major problem among active-duty personnel and vets, as this editorial in the New York Times points out. There were more than 295 suicides last year among active-duty soldiers. Kudos to President Obama for at least starting the process of, as he put it, "destigmatizing the mental health costs of war."

But we need to ramp up the conversation. We need to keep talking about the issue of war and mental health. We need to acknowledge that war damages people, that veterans struggle, and we need to do more to help them once they've done the dirty work of fighting for us. This blog explores some of the issues. Please take a minute to visit and leave a comment, and tweet the link to the blog. It's time we talked about it.

Book giveaway: We have a winner!

2011-06-29T20:02:00.003-05:00

Actually, we have two winners, because I couldn't bear to choose just one.

Madz and Psychocat, you have each won a copy of the UK edition of Brave Girl Eating. Congratulations! Please email me your snail mail addresses to harriet at harrietbrown dot com.

Thanks to everyone who left a comment. I'm sorry I don't have enough books to give away more.

Book giveaway!

2011-06-25T21:07:00.003-05:00

To celebrate the U.K./Australia/New Zealand publication of Brave Girl Eating, I'm giving away a copy of the book.

To enter, leave a comment on this post and tell me why you'd like to read the book. (Or, if you've read it already, what you liked about it.) I'll choose a winner at random this Wednesday, June 29.

Good luck!

NAMI in NYC, July 14

2011-06-20T11:03:00.002-05:00

Just a quick note to let you know I'll be speaking at a NAMI event about eating disorders on July 14 in New York City, along with filmmaker Jesse Epstein. The NAMI page has a link to the event flyer, but warning: it contains potentially triggering images. So I've put the details below. I hope to see you there!

Where: NYU Langone Medical Center, 550 First Avenue (between 32nd and 33rd Streets, Smilow Seminar Room
When: July 14, 6 p.m.
RSVP: 212.684.3264 (but I think you can show up without RSVPing in advance)

I need your advice and wisdom

2011-06-14T20:46:00.003-05:00

As you no doubt know if you're reading this, I've let this blog languish for a long time now. Too long. I won't go into the reasons for that lapse here, but I do beg your forgiveness. And so it's fitting that for my comeback post, I'm asking you for advice.

The advice isn't for me but rather is for a woman I'll call Mary, who's in her mid-30s and has been ill with anorexia since she was a teenager. She's been through in-patient, residential, intensive outpatient, outpatient treatment--you name it, she's been through it. And she is still sick.

Mary is smart and motivated. She understands what she has to do to recover: she has to eat. As for everyone with anorexia, eating is terrifying for her. Those of us who have re-fed a child or teen or young adult with anorexia know how very hard it is for someone with the illness to eat, and how much they need someone to stand with them and stand up to the eating disorder. Mary wants that very badly. She doesn't want to die. She wants to recover and knows, at this point, that she can't do it eating on her own.

Mary's dilemma has made me think long and hard about the need for a different level of care. I think one of the reasons FBT (the Maudsley approach) is successful most of the time is because parents care about their children in a different way than, say, administrators or caregivers at a residential facility care about their patients. I've come to believe that that love is part of the cure, maybe because it motivates parents to hang on through the toughest moments, or maybe because it's part of what breaks through the cognitive distortions of the illness. It doesn't matter why, really.

So I wonder: What if we created something like halfway houses for refeeding people with anorexia? Not residential facilities, with their (perhaps necessary) rules and restrictions and inevitably institutional feeling. More like a small house, with 3 or 4 people living there and round-the-clock nurses who developed real relationships with their patients. Who really cared about them. Who were capable of empathy and affection and, yes, maybe even love sometimes. There wouldn't be hours of group and individual therapy, because those things really don't help people until they're more or less weight-restored, so the cost could be much lower than the one to two thousand dollars a day cost of residential care.

What I'm really talking about is a kind of foster re-feeding home. I've given a lot of thought to inviting Mary to my home and re-feeding her, but there are some logistical challenges involved that I'm not sure are solvable.

So I put it to you: Do any of you know of resources for someone like Mary? Resources I'm perhaps not aware of? And what do you think of the idea of creating refeeding homes for people with anorexia?

I'm eager to hear from you. So is Mary.

Honor National Eating Disorders Awareness Week with Project BodyTalk

2011-01-29T06:49:00.006-06:00

The last week of February is National Eating Disorders Awareness Week, a week-long way to raise awareness of eating disorders, the devastation they cause, and hope for the future.

This year's theme is "It's Time to Talk About It," a notion I love because I'm all about talking about it, whatever "it" may be. Secrecy perpetuates bad feelings--let's get all the "its" out in the open. So I'm excited to be partnering with the National Eating Disorders Association to use that week to raise awareness and get people thinking in new ways--not just about eating disorders but about all of the crazy, disordered attitudes toward food and our bodies we hold in this country. This year I'm doing my part through Project BodyTalk, a web-based audio project I started two years ago to give people a place to talk about their relationships with food, eating, and their bodies.

If you're anywhere near the Syracuse, New York, area the last week of February, you can come to one of our open recording sessions. We'll put you in a private studio and let you record a commentary. You can choose to be anonymous, use a first name, or use your whole name. You can talk about something you love about your body, something you've struggled with, something you want other people to know about eating disorders--it's up to you. I'll be posting details on the sessions soon, but I expect they'll be held on campus at the Newhouse School, 3-8 p.m. every day that week. (Contact me for more info as the time gets closer.)

If, like most people, you don't live anywhere near Syracuse, or you can't make it to one of our sessions, you can still do your part by recording a commentary and sending it my way. Listen to some of the incredibly powerful and moving commentaries on the site for inspiration, and then make your own MP3 or MP4 file, or use a CD, and send it in through this handy web submission form. You can also hear an NPR program on Project BodyTalk here.

I hope you'll join me and Project BodyTalk this week for National Eating Disorders Awareness Week. Because you know what? It's really freaking time to talk about it.

San Diego Conference

2011-01-22T08:42:00.003-06:00

I'm sitting in the San Diego Airport, having gotten here at an ungodly hour for my flight back to NY. But I don't mind, because yesterday's Maudsley Parents conference was a great success.

The conference sold out, and our room was packed with a dynamic mix of clinicians and families.
The always cerebral Dr. Walter Kaye opened the conference with a friendlier-than-usual exploration of the neurobiology of eating disorders. Next up was Dr. Daniel leGrange of the University of Chicago, who took us through the history of research on eating disorders (distressingly meager) and explained in great detail the history of family-based treatment.

After lunch, we heard from Dr. le Grange and Dr. Renee Hoste, also of the University of Chicago, on clinical applications of the research. Last but not least, Roxie Rockwell of University of California-San Diego explained UCSD's wonderful week-long multi-family intensive program. (All PowerPoint slides are up on the Maudsley Parents website.)

Kudos to the main conference organizer, my partner-in-crime at Maudsley Parents, Jane Cawley, who by now really knows how to put on a great day.

And thanks to everyone who participated and attended. We're thinking New York City for our next conference. Stay tuned!

Dr. Sharma, I love you

2011-01-07T07:41:00.004-06:00

I love you for acknowledging what many of us know to be true: that people metabolize calories differently, that yo-yo dieting screws up people's metabolisms and causes weight gain in some people, and, most important, that shaming people inspires not healthy behaviors but self-destructive ones.

But don't take my word for it. Read this interview with the University of Alberta's Dr. Arya Sharma yourself.

I love the fact that, as this story from the CBC news points out, Sharma is the chair of obesity research and management at the University of Alberta and is still "no fan of most diets." And I love this quote from Sharma:

We keep hammering home the stereotype of the fat, lazy slobs who are eating fast food all the time who are not moving, not exercising or not taking care of themselves, making poor choices, when there's very little science that actually backs this up.

Thank you, Dr. Sharma, for saying it so plainly, so matter-of-factly, so clearly. I hope someone's listening.

*Photo © CBC.

Obesity and eating disorders: they're connected

2011-01-06T13:10:00.003-06:00

When I talk with doctors about eating disorders, I often end my presentation with a caveat to them, to be aware of how the current
"war on childhood obesity" can trigger eating disorders in those who are vulnerable. That's the point in the program where I often see one or two audience members sit back and cross their arms in a way that telegraphs plainly their disbelief and even disgust. (I've had people walk out at that point, too.)

If you think that's pushing things a bit too far, I'd like to call your attention to just one of the many "anti-childhood-obesity" websites I've run across lately. This one is particularly egregious, as it offers up cartoon characters that are both offensive and poorly illustrated (not to mention an obnoxious soundtrack, which you can turn off at the lower lefthand corner of the screen). The "cast" of characters here includes O-Bee-Sity, described herein as "s "the supreme fat lord of the universe" who can "turn kids into globs of fat with one slimy touch"; Phat Cells, which "have the ability to multiply and wreak havoc on the human body"; and--rather unbelievably--Anna-Rexia, who apparently hails from the planet Bulimia (don't these folks get the difference?) and both "infects little girls with eating disorders" and "despises" the rest of the cast (shown above).

Aside from the bad art and wild overuse of copyright symbols, there's some just plain bad information here. The site claims that childhood obesity causes not just diabetes, high blood pressure, and heart disease (all of which is still up for discussion, especially given the fact that we don't know whether obesity causes these ailments or whether the ailments themselves contribute to obesity), but also cancer, liver disease, asthma, and eating disorders.

Hello? Considering the fact that one of the "characters" here is "Dr. Smart," billed as the "secretary of health and fitness at the Pentagon," I'd like to think that someone was actually doing some research and not just spewing ill-founded and unsupported opinions as facts. Sadly, this is not the case. And I'd have to say that this is the norm for sites like this, which remind me of other zealous-but-ignorant campaigns.

In fact, as readers of this blog probably know, it's not obesity that causes eating disorders, but rather a combination of factors, mainly genetics and dieting. It's the war on childhood obesity--and on adult obesity--that's responsible for triggering anorexia, bulimia, and other eating disorders, not the condition of obesity itself. And the prejudice and stigma directed against the obese is likely responsible for many of the negative health outcomes we associate with weight.

Any way you look at it, websites like this one are not just ignorant or misguided; they're dangerous. And that's why I'll keep sounding the alarm when I talk to doctors. They need to know the consequences of their crusades.

Project BodyTalk on 51% this Thursday

2011-01-03T06:31:00.006-06:00

I'm delighted that the talented Susan Barnett, host of the nationally syndicated NPR show 51%, will be airing a segment this Thursday, January 6, on Project BodyTalk. This audio and web-based project collects commentaries (a la StoryCorps) on issues relating to food, eating, and bodies. This show includes a lively conversation between Barnett and myself, as well as clips from several audio commentaries made last year by faculty and students at the S.I. Newhouse School of Public Communications. You can hear the full commentaries on the Project BodyTalk website.

Here's a list of NPR stations that carry the show. I hope you'll tune in, and then visit the website to listen to more commentaries and upload your own.

Thanks to my amazing grad student from last year, Megan Swann, who took the photo above and created the website.

5 New Year's resolutions worth making

2010-12-29T20:41:00.003-06:00

I'm ready for the rash of media stories about New Year's resolutions with my own list of 5 resolutions that are truly worth making. Read all about it over on my Psychology Today blog.

Fat Body (In)Visible

2010-12-14T11:49:00.002-06:00

Kudos to fat activist Margitte Kristjansson, whose new video, "The Fat Body (In)Visible," is a compelling look at the world of fat acceptance and what it's like to be a fat woman in America today. Watch it below, and then leave Margitte a comment at her blog, Riots Not Diets.

fat body (in)visible from Margitte Kristjansson on Vimeo.

White Plains tomorrow!

2010-12-06T09:52:00.004-06:00

My apologies for not keeping up with the blog. Between full-time teaching and lots of travel for the book, it's been a challenging few months. But I promise more posts coming soon.

In the meantime, if you're in the White Plains, NY, area, consider coming out tomorrow night to hear the fabulous Dr. Evelyn Attia (pictured) and me talk about teens' relationship with food. Dr. Attia is a wonderful, smart speaker and I expect an exciting event.

Details:
New York Presbyterian Hospital
21 Bloomingdale Road
White Plains, NY

6:30 p.m.

Free!

See you there!

Maudsley Parents conference: San Diego, Jan. 21, 2011

2010-11-10T15:43:00.003-06:00

For those of you on the West Coast (or those who wouldn't mind a sunny interlude in January), Maudsley Parents is pleased to announce that registration is open for our next conference, scheduled for Jan. 21, 2011, in San Diego.

The fabulous lineup for this one-day conference includes a talk on the neurobiology of eating disorders by Dr. Walter Kaye of the University of California-San Diego; a talk on family-based treatment (FBT) by Dr. Daniel le Grange of the University of Chicago; an interactive session on FBT by Dr. le Grange and Dr. Renee Hoste, also of University of Chicago; and a dynamic presentation on multi-family treatment for eating disorders by Roxanne Rockwell, the lead therapist at the University of California-San Diego's Eating Disorders Program. I've worked with all of these professionals, and they're amazing. I'll also be doing a reading from my book, Brave Girl Eating.

Register before November 30 and get the early bird rate of only $60 for a day full of education (and lunch!). For more information, click here. Hope to see you in San Diego!

Reviewers wanted

2010-11-01T14:36:00.003-05:00

One of the most dispiriting aspects of book publishing these days is the disappearance of outlets for reviews. Once upon a time there were hundreds of newspapers that ran book reviews. Today there's just a handful. The result is that many, many books get no reviews in the mainstream book reviews.

I've been lucky to have Brave Girl Eating mentioned in a couple of magazines. Thanks to those editors! And a number of bloggers have reviewed it too, and I am grateful. Thank you!

Still, reviews are important to people considering buying the book, and so I'm asking you, dear readers, if you would consider writing a review of the book on Amazon.com if you haven't already. The book has been doing reasonably well and I'd love to see that momentum continue. New reviews help, believe it or not.

You have my eternal gratitude. :)

Another brave girl eating

2010-10-28T02:10:00.003-05:00

There are many roads to recovery from an eating disorder. Unfortunately, they're all hard roads. Some are longer, some are shorter, but all of them are steep and scary and require immense courage and persistence and support.

Which is why I find myself so moved by the story of Sofia Benbahmed, a young woman who's fighting through a long recovery made even longer by the fact that her insurance company refuses to cover her treatment. When I look into Sofia's face, I see my own daughter--the same spark, the same hope, and the same terror.

Please take a minute to read about Sofia and her struggle, and help her if you can--for all the brave girls out there.

Guest post: Shan Guisinger

2010-10-27T19:57:00.004-05:00

In my book Brave Girl Eating, I wrote about one theory of the origins of anorexia: psychologist Shan Guisinger's adapted-to-flee-famine theory.

I'm very pleased to have Dr. Guisinger writing about her theory on the blog today. I think it's a fascinating concept that deserves further thought. Please write in with comments and questions.

_____________________

Dear Harriet,

I’m happy that you described the adapted-to-flee-famine explanation for anorexia in Brave Girl Eating. I have found that it helps patients understand and fight their urges to restrict food and compulsively exercise.

The adapted-to-flee-famine hypothesis (2003) states that the distinctive symptoms of ignoring hunger, hyperactivity and denial of starvation were evolutionary adaptations that once helped starving hunter-gatherers make a last ditch effort to find better foraging grounds. This theory is supported by data from genetics, molecular biology and neuroimaging, yet eating disorders experts turn away from evolutionary explanations saying “we can never know for sure.” In fact, we regularly use circumstantial evidence and evidence based on probabilities to come to conclusions in science, the law, and in our lives.

For example, the criminal justice system has careful rules for evaluating circumstantial evidence because criminals rarely come forward to confess their crimes. Suppose someone were murdering teen-aged girls in your town. You would expect the police to arrest a man who had blood from the victims in his car, and you would expect a jury to convict him if the police found the murder weapon with his fingerprints, and if he had no alibi for where he was when the murders took place. How would you feel if the police let him go asserting that, without a confession, “we can never know for sure?” We would also be shocked if the judge let him go because he didn’t accept evidence based on probabilities, such as the DNA and fingerprint data.

This issue is not simply academic jousting. According to NIMH, the mortality rate for anorexia of 5.6% per decade is twelve times higher than the annual death rate due to all causes of death among young women between the ages of 15 and 25. And treatments based on the conventional assumptions have a dismal success rate. In fact McIntosh and colleagues found that patients in what was supposed to be the control group, given only nutritional counseling and emotional support, did better than those given cognitive-behavioral or interpersonal therapy which assume that anorexia is caused by psychological issues.

What is the evidence for the adapted-to-flee-famine hypothesis?

First, anorexia is now accepted as genetic. Although rare in the general population, if one identical twin has it, there is a 50% chance the other will develop it. Studies comparing identical and fraternal twins found that the increased risk is due to genetics and not to family environment. Moreover, the lack of long-term success of weight-loss programs demonstrates that without anorexia genes it is very difficult to maintain weight at 15% below normal. What anorexics do is physiologically and psychologically remarkable.

Second, denial of starvation and body size overestimation are demonstratively the result of unconscious machinations at the neuronal level. Brain imaging shows that the brain alters the reality that an underweight anorexic individual consciously perceives. When an anorexic looks at herself, her brain actively inhibits perceptual processing of visual input. This makes sense if the brain were trying to fool a starving person into thinking that she has the physical resources to travel.

Third, neuroendocrinologists have described the complex physiological changes that enable starving people with anorexia to feel like running for miles and refuse food offered. When leptin, a hormone that tracks fat stores, falls below a critical level, it activates neuronal circuits that reduce food intake and increase activity (Muller, 2010). Chen and colleagues (2004) have identified the gene, SIRT 1, that turns on hyperactivity in starving mice.

Natural selection is the only process that can produce such a network of specialized abilities, but ED researchers explain them as the result of a hodgepodge of biological breakdowns. Each favors a different dysfunction, for example, excess serotonin, impairments in set shifting, errors in reward pathways, and breakdowns in sensory integration.

The idea that biomedical dysfunctions are responsible for anorexia nervosa does not stand up to logic. For a person to develop the standard presentation of anorexia (difficulty eating, hyperactivity and body image distortion) at least three different accidents would have to happen together. The likelihood of this is very small. Moreover, the fact that the crucial biological changes of anorexia normalize with weight restoration indicates that they are a response to very low body weight, and not the cause.

In your book you eloquently describe how hard it is to recover from anorexia. It matters why people with anorexia feel they must restrict food and exercise. It matters in order for treaters to understand and help their patients; it matters to the person with anorexia to make sense of her experience of difficulty eating, drive to move, and body image. Treatment is often ineffective because, still today, most patients, therapists and doctors believe that anorexia nervosa is caused by the patient’s willful refusal to eat due to a need for control or to trying to be model thin. Their false belief is the result of the mind’s automatic attempt to make sense of anorexia’s puzzling feelings and behaviors.

Realizing that their bodies are trying to migrate helps people with anorexia overcome their anorexic urges; and, it helps their loved ones and their therapists to understand their struggle and perhaps support them in recovering their health.

Sincerely,

Shan Guisinger, PhD
shan.guisinger@mso.umt.edu

Family-based Online Bulimia Study

2010-10-21T12:55:00.001-05:00

Hi y'all,

Please pass the word about the study below. I'm thinking it could be wonderful treatment for the right families. University of Chicago is at the forefront of research on ED treatment, and I trust their protocols completely.

************************************

The University of Chicago is conducting a research study designed to examine the efficacy of an Internet-based program for parents with adolescent children who show early signs of bulimia nervosa. We are seeking families who have an adolescent (ages 12-17) who engages in binge eating (large amounts of food in a short period of time) and/or compensatory purging (e.g., vomiting). Participating families will use an Internet-based program to address their adolescent’s eating disorder symptoms.

To be eligible:
* Families with an adolescent child (ages 12-17)
* Adolescent demonstrates eating disorder symptoms

For information call:
Colleen Stiles-Shields at 773-834-5677 and mention your interest in the Family Internet-based Early Bulimia Nervosa Study

or e-mail Jocelyn Lebow:
jlebow@yoda.bsd.uchicago.edu

or, to learn more, or to register online, visit:

http://epathprogram.org

Family-based treatment in the New York Times

2010-10-18T16:55:00.003-05:00

Great story by Roni Rabin in tomorrow's New York Times about family-based treatment for anorexia. Nice interviews with Rina Ranalli, whose daughter recovered using FBT; Dr. Daniel le Grange of the University of Chicago; and moi.

Change is coming. And it's about bloody well time.

In honor of Love Your Body Day

2010-10-17T12:52:00.002-05:00

I thought I'd repost Joy Nash's original Fat Rant from 2007. It still rocks, y'all, and sadly, it's still oh-so-relevant.

Hope for teens with anorexia

2010-10-13T07:31:00.002-05:00

The release last week of the long-awaited results from a five-year multi-site study confirmed what many of us already knew: family-based treatment for anorexia works. In a controlled randomized study, FBT worked better than traditional individual-based psychotherapy: More than half the patients getting FBT recovered, compared with less than a quarter of those getting the other treatment. And far fewer in the FBT cohort relapsed.

This is great news. There's more work to be done, of course; a 50 percent recovery rate is not acceptable. But it's so much better than the usual statistics: people with anorexia stay sick for five to seven years, and only about a third recover.

Read more here on my Psychology Today blog.

Watch this, then watch what you watch

2010-10-08T07:26:00.001-05:00

Thanks to Lori Shuldiner Schor for sending this great video my way. Take a look. Pass it along.

NEDA, here I come!

2010-10-08T07:22:00.003-05:00

Looking forward to meeting some of you at NEDA this weekend. Tonight is a dinner for the PFN--I'll be there along with my ch-chair at Maudsley Parents, Jane Cawley. Saturday night there's a meet and greet and signing for authors at the conference--I'll be signing Brave Girl Eating. And I'll be presenting along with Dr. Walter Kaye on Sunday afternoon at 3. Hope to see you there and around the conference!

Serotonin and depression

2010-10-07T20:28:00.003-05:00

I just couldn't resist reposting* this link to a blog that questions the relationship between serotonin levels and depression. The conventional wisdom is that antidepressants like sertraline and fluoxetine increase levels of serotonin in the brain and that's what alleviates depression. This blog asks why, then, antidepressants don't work right away, since they begin raising those levels immediately. And if you've ever started an antidepressant feeling rather desperate, you're extremely aware of every day it's not working.

It's all about neurogenesis, according to this blogger—the ability of the brain to generate new cells. Depression may be linked to lower levels of neurogenesis. One thing antidepressants do—after several weeks—is increase neurogenesis.

Fascinating stuff.

*Thanks to Carrie Arnold at Ed Bites for the original link.

University of Wisconsin Medical School talk

2010-10-07T16:26:00.003-05:00

I find it uber-creepy to watch myself on video, so I'm linking this talk I gave last week at the UW Medical School without actually watching it.

If you happen to take a look, let me know how it looks. I'll take it down if it's not very good.

The study results are in!

2010-10-05T07:53:00.004-05:00

And they're clear and well-supported: For teenagers with anorexia nervosa, the first-line treatment should be family-based treatment (FBT), also known as the Maudsley approach.

I think the days of FBT being labeled as a marginal, alternative, or "very special" treatment for "very special families" are officially over. For a high percentage of teens with anorexia, FBT works--they recover, and they stay recovered.

Does it work for every single family? Nope. But then neither does chemotherapy, or penicillin, or other mainstream treatments we don't question. (For an inside look at how it worked for our family, see my new book, Brave Girl Eating.)

Now, the hard part: Training enough FBT therapists so that more families have access to them. Luckily, someone's already on the case.

We still need more research. We still need better techniques. But there's no question that this is big news, and important news, for families and clinicians.

Big congratulations to Dr. Daniel le Grange and Dr. James Lock, who co-authored the study.

Can you say disconnect?

2010-09-22T14:10:00.004-05:00

That's the only word that came to mind when I read this story on Time.com about the extra costs women pay for being obese.

According to researchers at George Washington University, women who are obese lose twice as much money—nearly $5,000 a year—as their obese male counterparts. But not because they use more health-care dollars. The difference comes mostly from discrimination.

Fat women are paid less than women who aren't fat; fat men, on average, earn comparable salaries to men who aren't fat. So women are penalized by employers for being fat.

This says something about how women are perceived in our culture, and it's not news. But it is newsworthy, because, damn it, it's 2010 and we're supposed to be better than this as a society. All the young women who don't identify as feminists because they don't have to fly that flag anymore should take note of studies like this one. Gender discrimination is alive and well in 21st-century America.

But that's not where the writer of this story went. No, her conclusion was quite different. She wrote, It's bad news, but maybe it will help fund better prevention strategies and new treatment methods for this growing scourge.

Excuse me? Did I hear you right? The answer to discrimination is getting rid of the quality that's being discriminated against? How about taking on the concept of discrimination instead? How about educating people about the emotional and other costs of fatphobia, and about how discrimination (and its attendant stressors) actually makes people fatter?

I'm not surprised; this is exactly the kind of disconnect I've seen over and over in the media. It's as if we are constitutionally unable to see the logical extension of our behaviors around weight, especially when it comes to women.

Big fail.

Going through hell? Keep going

2010-09-11T13:34:00.004-05:00

That's one of my favorite quotes, from Winston Churchill, as it happens, and the title of my newest post over at Psychology Today. See you over there.

Interview at CarolineLeavittville

2010-09-08T09:02:00.004-05:00

Thanks to writer, reviewer, and blogger extraordinaire Caroline Leavitt for posting a thoughtful, thought-provoking interview about Brave Girl Eating on her blog today. I love it when interviewers really get the book--and Caroline did.

Reviewers wanted

2010-09-06T08:23:00.006-05:00

I have a favor to ask, dear readers.

If you've already read Brave Girl Eating: A Family's Struggle with Anorexia, would you write an Amazon review of the book? It doesn't have to be long or complex--a two-sentence comment can work just fine.

People actually read those reviews, and make decisions about what to buy from them. I'm doing everything I can to get the word out--not just about the book but about family-based treatment as an option for families.

A great big thank you to you!

Photo ©Forest Wander.

Getting her to eat

2010-08-27T07:00:00.005-05:00

In my new blog, Brave Girl Eating, for Psychology Today, I wrote about how we got our daughter to eat when she was in the grip of anorexia. Read it here. I hope it's helpful to those of you who are struggling to help a child or teen with anorexia.

The Diane Rehm Show

2010-08-27T06:52:00.002-05:00

Thanks to Lynn Grefe, CEO of the National Eating Disorders Association, and Ovidio Bermudez, M.D., for taking part in the Diane Rehm Show yesterday with me. The subject was eating disorders, and we talked a lot about family-based treatment (the Maudsley approach) as well as Brave Girl Eating. It was an inspiring conversation and I am grateful to all who took part.

You can listen to the segment here.

Atchka!

2010-08-23T21:38:00.005-05:00

Thanks to Shannon Russell (alias Atchka) for a good interview about anorexia, Brave Girl Eating, evolution, and other enthralling subjects. You can listen up here.

Russell blogs on a site called Fierce Fatties. It's worth checking out.

I'm happy to report I did not drop the F bomb in this interview. But, like, I really have to, like, stop saying like all the time. Like, know what I mean?

Good Morning America: Cancelled

2010-08-21T07:58:00.004-05:00

Please note that my Good Morning America appearance, scheduled for 8/24, has been cancelled for reasons beyond my control.

But there are plenty of other stops along the book tour! Next week: a talk/reading at the Center for Eating Disorders at Sheppard Pratt in Baltimore, and a stop at the Diane Rehm Show in D.C.

Please pass the word about the book--my publisher tells me that early sales figures are the most important. I'd love to see the book gain some momentum in the first weeks after it goes on sale 8/24.

Thanks for all your support!

*I don't know why this image from Mrs. Doubtfire comes up when you search for brave girl eating, but it amuses me.

5 warning signs that your child might have anorexia

2010-08-19T20:49:00.003-05:00

Read it at Brave Girl Eating, my blog on Psychology Today's website, and please pass the information to any parents you know who might need the information.

How I wish I'd had this list before Kitty got sick.

Sheppard Pratt Q&A, part III

2010-08-18T12:56:00.002-05:00

I'm looking forward to speaking at the Center for Eating Disorders at Sheppard Pratt in Baltimore next Wednesday, Aug. 25, at 7 p.m. I'll be talking about and reading from Brave Girl Eating. Please come out and say hey if you're in the Baltimore area!

Meanwhile, check out Part III of an online Q&A I did with them, which includes 4 essential tips for parents.

For a complete list of stops on the book tour, click here. Hope to see you somewhere along the way.

Memoirville

2010-08-17T18:19:00.004-05:00

Here's an interesting interview about Brave Girl Eating on Memoirville, home of Smith Magazine's Six-Word Memoir Project. You'll have to get all the way to the end to read mine.

Note to self: Do not drop the F bomb during interviews.

When families deal with health crises

2010-08-16T17:16:00.004-05:00

If your family has ever dealt with a health crisis--whether it's an eating disorder or not--you've probably noticed that some friends step up while others back away. This New York Times piece looks at some of the very common and human reasons why we all back away sometimes, and offers advice for how to be a better friend when those you love are going through something big.

And if you'd care to join an online discussion on the subject, you can do that here.

Jezebel on parents and eating disorders

2010-08-16T14:06:00.003-05:00

Jezebel writer Anna North put up a piece today based on an interview we did last week about not just my new book, Brave Girl Eating, but the whole notion of family-based treatment.

The comments, sadly, reveal some of the biases against FBT (the Maudsley approach). Take a look and leave a comment if you are so moved--I think Jezebel readers would benefit by hearing from some who have had positive experiences with FBT.

I'm off to do some deep breathing.

She's not that skinny. Is she?

2010-08-13T19:36:00.004-05:00

Why you can't tell if someone has anorexia just by looking. Read about it on my new blog, Brave Girl Eating, here at Psychology Today.

Photo © Steve Pope Photography

We need more FBT therapists!

2010-08-13T10:30:00.007-05:00

If you're a therapist who treats eating disorders and you'd like to become certified to do family-based treatment (also known as the Maudsley approach), you're in luck. The Training Institute for Child and Adolescent Eating Disorders, run by Drs. Daniel le Grange and James Lock, is hosting a two-day training in Chicago, September 13-14.

For information and to register, visit the Training Institute's website. Because heaven knows we need more FBT therapists around the country/world!

"My daughter's not fat"

2010-08-12T11:56:00.002-05:00

This kind of nightmare is what happens, folks, when we have mandated "reporting" of BMIs and other ridiculous "measures" of thinness/fatness. Especially for children, who are still growing and who do not grow in a linear fashion.

This particular incident happened in the UK. But it could easily happen here, now that states like Arkansas and New York require it, and other states are considering it.

You say that this is an extreme case? That overall, BMI reporting is a good idea? Read these talking points from the Eating Disorders Coalition.

Our language around these issues is loaded and complex, because we have made it so. We've made fat a dirty word that connotes so many negative qualities: lazy, greedy, sloppy, messy, stupid, unattractive . . . . No wonder 11-year-old Katie Owen reacted the way she did. She's not the first, and she will not be the last.

Brave Girl Eating: Q&A, Part II

2010-08-12T10:14:00.002-05:00

The second part of the Q&A on Sheppard Pratt's blog is now live. I hope you'll check it out. Drop me a comment if you're in Baltimore and think you might make the reading--I'd love to meet you!

Brave Girl Eating: Q&A

2010-08-09T11:43:00.003-05:00

In preparation for my upcoming book talk at the Center for Eating Disorders at Sheppard Pratt, the kind folks there are posting a Q&A interview on their blog over the next 10 days or so. Part 1 is up. And if you're going to be in Baltimore on August 25, please stop by the reading--I think it's going to be an inspiring event.

100,000 hits

2010-08-05T09:21:00.003-05:00

When I started this blog in 2006, I had no idea I'd still be at it four years later.

Today, the 100,000th visitor stopped by the blog. I realize that's not a huge number, given stats on the big blogs. But for a little independent blog like this, it feels huge.

So thank you to my readers, those who agree with my opinions and those who don't, those who educate me and those who merely lurk. I am richer for having you as part of my community, and I hope I've offered something back in return.

As a way to say thank you, I'm going to run a book giveaway on the site. Stay tuned for details!

Don't get mad. Get out your Exacto knife.

2010-08-05T05:46:00.003-05:00

That's what this furious citizen did when confronted by an offensive ad for thin pretzels.

What if we all "corrected" ads like this? They can't arrest all of us. . . .

Annals of retouching disaster: The Ann Taylor shirt

2010-08-04T10:23:00.012-05:00

Thanks to a technical screw-up by someone at Ann Taylor (I'm thinking heads will roll over this), Jezebel was able to grab screen captures of a model before and after retouching.

Here's what the site ran:

You can see the work that's been done. As Jezebel put it, the "unretouched thumbnails . . . transform [models] into ribless monstrosities."

The model on the left--the unretouched one--is beautiful, shapely, and wears the clothing well. So why, why, why turn her into the absurd image on the right? I don't think it's enough to cite the pursuit of thinness. The model on the left is already thin--you can see her ribs, for God's sake. I think there's something more at stake here. Something that has to do less with beauty-qua-beauty and more to do with how women are perceived in 21st-century America--and how we perceive ourselves.

I can't help thinking about the timing of all these retouching debacles. There was the Calvin Klein photoshop disaster:

Then there was the Self magazine Kelly Clarkson debacle (see below).

Technology has something to do with it, of course. We photoshop because we can, because human beings are compulsive changers-of-reality and even more relentless self-improvers, and can't pass up an opportunity to "iimprove" ourselves.

Except that these kinds of "improvements" are so far out of the mainstream, no one (I hope) would confuse them with reality. Which brings me back to the idea that there's something more going on here.

Women have never been as powerful in America as we are today. And even though we still have a ways to go (can you say "woman president in my lifetime?), we've made enormous progress since I was a young thing. And thanks to the Great Recession, women's work and employment levels may be surpassing men's for the first time.

And maybe that's the problem. Maybe the Trojan Horse of self-loathing embodied in images like these is meant to put us uppity women in our place. I've said it before and I'll say it again: So long as we're obsessed with our appearance, our looks, how thin we are or aren't, we're missing the boat on a whole lot of more important issues.

I can't help thinking there's a connection.

Psychology Today

2010-08-02T08:09:00.002-05:00

Over the next few months I'll be blogging over at Psychology Today as well as here on Feed Me!. PT has an impressive roster of bloggers who tackle some fascinating issues, and I'm honored to be among them. I'll link to my posts there, starting with my inaugural post; those posts will focus on eating disorders. I'll still post here about other issues of interest.

If you head over there and read the blog, and like it, leave a comment if you would--make me feel at home there. :)

Happy Monday!

Book tour!

2010-07-29T12:53:00.007-05:00

The last few weeks have seen a lot of action on the book tour front. I'll be traveling quite a bit to readings, events, and conferences to talk about Brave Girl Eating: A Family's Struggle with Anorexia.

I thought I'd post an up-to-the-minute calendar of where I'm scheduled to be so far, with more to come. You can also look for my schedule here. If you come to a reading, please introduce yourself! I look forward to meeting some of you while I'm on the road.

8/24: Appearance on Good Morning America, 7 a.m.?
8/25: Reading at Sheppard Pratt Center for Eating Disorders, Baltimore, 7-9 p.m. in the conference center
9/20 The Book House, Albany, NY, 7 p.m.
8/26: Appearance on the Diane Rehm Show, 10 a.m.-noon
9/24: Presentation/book talk, Lake Forest College, 10 a.m., Lake Forest, IL
10/1: Reading/book talk, University of Wisconsin, Room 1244, Health Science Learning Center, noon
10/2: Reading/book talk, Wisconsin Book Festival, 10 a.m., A Room of One's Own Bookstore, Madison, WI
10/4: Reading/book talk, Moline Public Library, 10 a.m. (subject to change in location)
10/4: Talk/reading, Quad Cities Eating Disorder Consortium training for therapists, 3 p.m., Moline, IL
10/10: Presentation with Dr. Walter Kaye, National Eating Disorders Association annual conference, 3 p.m., Brooklyn, NY
1/21: Presentation/book talk, Maudsley Parents conference, University of California San Diego, 11:30 a.m., San Diego, CA

Poor Dr. Lundberg

2010-07-27T07:12:00.003-05:00

Apparently Dr. George Lundberg is a little upset because back in 2004, he put forth his ingenious stop-obesity plan and it didn't work. And it didn't work, he tells us, because fat people just didn't listen to his plan, which is really simple and practical when you think about it. It consists of two words:

Stop eating.

Dr. Lundberg goes on to clarify what he means:

I did not say fast; I did not say starve. I said Stop Eating too much; stop eating high calorie snacks between meals, stop eating everything on your plate; stop eating such large portions; stop eating desserts; stop routinely eating bread and butter; stop eating three full meals a day when two are enough; stop eating fats and refined carbohydrates when you can eat fresh fruits and vegetables and complex carbohydrates.

And while you are at it, STOP DRINKING alcohol and sugary drinks.

I wonder if Dr. Lundberg understands anything at all about metabolism. If he did, I suspect he would not so angrily and aggressively put forth his diet plan--because that's what it is, a diet plan, one built on restriction. He would know that dieting, restricting, whatever you want to call it, ultimately makes people fatter, not thinner. He would show more sensitivity to the link between dieting (or restricting, etc.) and eating disorders. And I hope he would not so blithely recommend gastric "interventions," as he writes a few paragraphs farther down, which not only are often unsuccessful but which carry relatively high risks of death, infection, malnutrition, blood clots, and other consequences.

He writes rather plaintively, toward the end of his editorial, "A lot of obese people got really angry at me for hurting their feelings. But I don't really care that much, as long as we did get some people to adjust their eating and drinking behavior. STOP EATING and DRINKING EXCESSIVELY and STAY HEALTHY."

Tell me, Dr. Lundberg, what is "excessively"? To me it sounds like you think three meals a day is excessive. You think any amount of dessert is excessive. You think any amount of fats or refined carbohydrates is excessive.

Whereas actually, I think you're the excessive one. Your rules, restrictions, and most of all your rigidity and, yes, rage--what do these remind me of? Oh, yes, I remember. They remind me of the rigidity, rules, and rage of an eating disorder. You know, a lot of people think there's nothing wrong with having a little eating disorder, as long as you're not fat.

Those of us who have seen or experienced an eating disorder up close feel rather differently about that, of course. And I'll tell you what I think, Dr. Lundberg: I think you should confine your judgmentalism to yourself. You are free to eat and drink (or not eat and not drink) to your heart's content. You are free to manipulate your weight as much as you want.

And you're free to say whatever you want, of course, just as I am. But I hope to God, Dr. Lundberg, that you might educate yourself a little more before you spout off next time about obesity. I hope you'll talk to some people who know a little more than you about eating disorders and metabolism and all that complicated science-y stuff. I hope you'll talk to some families with children with eating disorders, and listen to them say their daughters and sons developed those eating disorders after middle school wellness classes that scared the crap out of them around being fat.

Until then, I hope you're not a practicing doctor anymore. I would hate to think of anyone I care about experiencing your judgmentalism, rigidity, and rage.

Guest post

2010-07-26T07:16:00.002-05:00

Thanks to Amy L. Cambell for letting me write a guest post on her blog, A Librarian's Life in Books.

Campbell asked me to talk about why I wrote the book Brave Girl Eating: A Family's Struggle with Anorexia. I'm glad to have the chance to articulate it, to you as well as to myself.

Hop on over and visit Campbell's blog if you have a chance--I love supporting people who love books!

Distortions

2010-07-25T07:10:00.003-05:00

When it comes to talking about eating disorders, there's no end to the distortions that often get trumpeted as "new." If you've had a loved one suffer with an eating disorder you know what I'm talking about. One of the things I teach my magazine journalism students is the fine art of taking a press release and turning it into a compelling and accurate piece of journalism. It's the toughest lesson we do all semester, which is no reflection on them. I think it's a challenging task to pull off, and very few news or public relations entities do it well.

To wit: This story from PR Newswire, whose headline trumpets "Mommy Not Always Dearest During Treatment for Eating Disorders." If you read only the headline and the first paragraph or two you'd come away with the idea that mothers were devastating, damaging, and destructive factors in their daughters' recovery from an eating disorder.

If you can force yourself past those first paragraphs, you'll be able to intuit a slightly more nuanced story. The family therapist quoted in the story, Catherine Weigel Foy, makes comments like "The mother-daughter relationship can be a complicated one." Um, yep. There's nothing particularly ground-breaking or earth-shattering in that statement. She goes on to say, "A mother's love begins before a child is born, and can create an unrealistic expectation that the connection between mothers and daughters will be as strong and free from limitations in adulthood as it was in early infancy."

I'll buy that, too, though perhaps I'm a bit more optimistic than Weigel Foy about the potential for good relationships between mothers and daughters.

Read down another paragraph or two and you find this:

Weigel Foy endorses an introspective look at this unique relationship and believes temporary distance from family members allows many adolescent and teenage girls to feel safe exploring the mother-daughter relationship in ways they haven't been able to during prior treatment for anorexia or bulimia. Weigel Foy and her colleagues at XX XX Residential Treatment Center work together to foster a nurturing environment that helps teen girls gain a realistic view of their relationship with their mothers. In turn, the girl and her mother are better equipped to support each other on their path to recovery.

Aha. Here, ladies and gentlemen, if we are attentive readers, the light bulb goes off. We understand that the piece we're reading isn't journalism at all but PR on behalf of XX XX Residential Treatment Center (I've deleted its name because I don't want to give it more publicity). Weigel Foy may be a good therapist or she may not; we really can't tell from this paraphrasing of her work in the service of publicity.

But certainly, the average reader will come away from the headline and opening paragraphs thinking, "Wow, this doctor thinks mothers are responsible for their daughters' eating disorder and/or get in the way during recovery."

Later in the piece, the writer concludes, "Through residential treatment and therapy this relationship can be explored and these young girls can come to better understand its affect on their diseases – and in turn help build a foundation for lifelong recovery." The mother-daughter relationship is being offered up as a reason to send your child to residential treatment.

Here I must point out that not only is there no evidence whatsoever that the mother-daughter relationship plays a causal or continuing role in eating disorders, but there is also no evidence whatsoever that exploring this relationship helps anyone get over an eating disorder. To the contrary: The most effective treatment for adolescent eating disorders is family-based treatment, which enlists the support of the family--mothers included--to help teens and young adults recover. And when I say "the most effective treatment," I am referring to real studies with real results, not one therapist's opinion (no matter how good she may be).

This kind of media deconstruction is important for everyone these days, as we're bombarded by information. But it seems to be especially imperative in the murky, vague, profit-seeking world of eating disorders treatment. Caveat emptor.

New website

2010-07-19T20:17:00.003-05:00

Here's a huge shout-out to my talented husband, photographer Jamie Young, who is creating a new website for me. Take a look and tell me what you think--your input welcome! I'll be posting some of the fall events I've got lined up for the Brave Girl Eating book tour in the days and weeks to come.

The book is coming, the book is coming . . .

2010-07-17T19:42:00.002-05:00

There seems to be some buzz building for the Aug. 24 release of my new book, Brave Girl Eating: A Family's Struggle with Anorexia. I feel honored! And I wish I had galleys to send out to everyone who wants to read it. (My publisher would like me to say instead, "I wish you would all buy it!")

So I thought I'd post a link here to the incredible book trailer a student, Shelby Haddon, made for me last spring. It uses some of the material that opens the book.

In the weeks to come I'll post short excerpts from the book. Of course I wrote the book and I want it to find an audience. But beyond that, I want it to make an audience--people who don't know much about eating disorders except what they hear on the news or in magazines. Why should they care? Because chances are, someone they know and care about has an eating disorder but isn't talking about it. People feel shame and stigma about having eating disorders, and unfortunately the secrecy around them feeds the flames of that kind of stigma.

No more secrecy. No more stigma. I believe in telling the stories, true stories. People need to know and understand and empathize with what other people are going through.

Enjoy the trailer.

Looking for young adults with anorexia

2010-07-15T14:05:00.003-05:00

Researchers at the University of Chicago, under the direction of Dr. Daniel le Grange (pictured, left), have just won an NIH grant to study family-based treatment (FBT, also known as the Maudsley approach) in young adults. If your family lives in the Chicago area, or within driving distance, you could get free treatment if you qualify for the study. Not to mention the chance to get some of the best treatment for anorexia in the country. It's a win-win!

Here are the study parameters:

This study is a good match for you if you are:
• 18 to 25 years old
• Meet diagnostic criteria for anorexia nervosa
• Are prepared to participate in assessments
• Interested in cost-free psychotherapy treatment with a family member of choice

Treatment involves up to 6 months of free individual and family therapy sessions.

For more information, please contact the Participant Coordinator at 773-834-9120 or visit University of Chicago here.

Michelle Obama: Starting to get it?

2010-07-13T22:40:00.002-05:00

Maybe so, if this story from the Christian Science Monitor is to be believed.

The First Lady goes on record saying she "tries to stay away from discussions about weight with her daughters," focusing instead on health. Though I notice she's still willing to talk about weight with the rest of our daughters. And sons.

Well, change comes slowly. Good start, Mrs. Obama! I hope you'll keep listening as well as talking. And if you've got another place at the table for your September summit on childhood obesity, please count me in. . . .

PHOTO CREDIT: AP PHOTO/ED ZURGA

UC-SD is looking for research participants

2010-07-07T06:14:00.003-05:00

One of my next posts is going to be a love letter to the team at UC-San Diego.

Meanwhile, if you live on the west coast and would like to participate in a brain imaging study there, please consider doing it. The folks at UC-San Diego, under the direction of Walt Kaye, are doing some of the most important cutting-edge work on the neurobiology of eating disorders. This is your chance to help them out, get a scan of your brain, and make a little money. Details are below.

RESEARCH PARTICIPANTS WANTED
In conjunction with Dr. Walter Kaye and his research team, Dr Amanda Bischoff-Grethe is seeking female participants between 12 and 18 years of age who have a recent (within the last six months) diagnosis of Anorexia Nervosa. Qualified participants will be asked to answer questions regarding their personality and cognitive abilities and will also undergo a 1.5 hour brain imaging study. By participating in this research study you may assist physicians and researchers in developing treatments for these complex and serious disorders. You may be compensated up to $175 dollars plus mileage. For more information, please contact the UCSD Eating Disorder Treatment and Research Program at edresearch@ucsd.edu or the Research Coordinator, Zoë Irvine, at 858-246-0699. We look forward to working with you!

Independence Day

2010-07-04T08:23:00.006-05:00

July 4th is a time to celebrate freedom: freedom from tyranny, from oppression, from authority. These are concepts we typically think of in the context of politics. I've been thinking about a different kind of freedom this year: freedom from eating disorders.

The analogy is apt, though most people don't know it. Having an eating disorder is like being a slave, subject to the whims and demands and impossible expectations of a taskmaster well-versed in the art of punishment. When you have an eating disorder, you do what it says, whether that's to refrain from eating even though you're starting, or to purge every calorie you do eat, or to stay awake when you're exhausted (because you don't deserve to sleep/eat/live). Having an eating disorder is the very opposite of freedom. You're not free to choose when it comes to some of the most fundamental elements of your life.

Anyone who's had an eating disorder can tell you that it's not a choice. You are not exercising free will every time you stick your finger down your throat, or push away a plate. You're in the grip of an irrational tyrant who has no regard for your feelings, your health, your sanity.

So this July 4th, I'm thinking about everyone who's ever struggled with an eating disorder, who's felt the iron grip of tyranny around her throat, stomach, mind, and who is struggling to become free. I want you to know that you can become free. There is hope. There is life outside of the crushing oppression of an eating disorder.

And here's to it, and to you.

Project BodyTalk goes live!

2010-06-28T16:42:00.007-05:00

After nearly a year of development and work, I'm pleased to announce that thanks to my fabulous graduate assistant, Megan Swann, we've got a website up and running for Project BodyTalk. I've been writing about eating disorders for a while now, and at some point I began thinking that it would be really fabulous to be able to hear the actual voices of people who struggle with EDs. I'm also a radio devotee and big fan of shows like This American Life and the StoryCorps project.

From these sources, Project BodyTalk was born. It's an audio project that collects commentaries on the subjects of food, eating, body image, and eating disorders. Here on the Syracuse University campus, we opened a recording booth for a couple weeks last fall and collected a number of commentaries from students, faculty, and community members who came up to campus to record. Since then I've had people send me mp4 and mp3 files. A couple of teachers at a high school in Baldwinsville had students record commentaries.

The first commentators were told to record a commentary anywhere from 1 to 10 minutes, on any related subject. Some people told stories about friends and family members struggling with body-related issues. Some talked about foods they love. Some talked about what it's like to be fat, or thin, to have anorexia or binge eating disorder, to feel pressured to look a certain way. It's turning into a wonderfully eclectic, diverse, and moving project.

So . . . the website is up and running with the first half dozen commentaries. Over the next few months I'll be editing and uploading more commentaries, and, I hope, collecting them too.

We've also got a page labeled ACT, where I'm posting links and descriptions of other body-positive projects. If you've got one to share, send me info, and I'll happily add yours to the page.

I'd love your feedback--and your commentaries.

*Image by Megan Swann.

Bring Brave Girl to your town!

2010-06-15T23:28:00.004-05:00

I've started planning a book tour in earnest for BRAVE GIRL EATING, my memoir about our family's struggle to help our daughter recover from anorexia. My goal: To visit as many towns, especially university towns, as possible, and to get in front of as many pediatricians, doctors, therapists, and families as I can.

Here's where you come in, dear readers: I need your help arranging events in your town. I'm aiming to get on the schedule for university lecture and talk series, because I know this book will be of interest to both the scientific community (it's got lots of science and neurobiology for all you geeks, and I count myself among you) and to college audiences. The best way for me to make contact with folks around the country is through someone who's already in the community and who can broker an introduction and help me connect with the right person.

I'd love to come speak in your town, at your university, in your state--hell, in your doctor's office. So if you can help please let me know. My email addy is harriet at harrietbrown dot com. Tentative schedule to come in the next few weeks, I hope!

Are you a size-accepting fat woman?

2010-06-08T19:34:00.003-05:00

If so, please consider helping grad student Micheala Null, a doctoral student in sociology at Purdue University, by taking a brief study and potentially doing an interview. Details are below.

*********************

Call for Participants

Hi, my name is Michaela A. Null, and I am a doctoral student in Sociology at Purdue University. I am doing a study about the embodiment of size-accepting fat women, with attention to the ways in which gender, race, sexual orientation, and
body size intersect.

I am currently looking for individuals who are interested in volunteering to participate in my study. If you are interested in volunteering to participate in an interview, I ask that take an electronic informational survey, which will take approximately 5 minutes. Please go here and complete the informational survey. After all survey data has been collected, participants will be selected for interviews, which will be conducted in-person, by phone, or via internet chat, and will last between an hour and an hour and a half.

Participation is voluntary and participants must be at least 18 years old.

This project has been approved by my university’s Institutional Review Board, which protects human subjects of research. I will provide confidentiality to all volunteers and participants will be referred to by a pseudonym in all research documents.

If you have any questions regarding this study, you can contact me at mnull@purdue.edu. For more information on me, you can access my university profile here.
You can also contact Professor Eugene Jackson, Assistant Professor of Sociology at Purdue University, at jacksone@purdue.edu.

Sincerely,

Michaela A. Null
Doctoral Candidate
Instructor for Women's Studies
Purdue University
Department of Sociology
700 W. State Street
West Lafayette, Indiana 47907-2059

Check the Huffington Post . . .

2010-06-01T15:09:00.003-05:00

for my response to the White House Task Force on Childhood Obesity.

Add your comments, please. I'm sure there will be plenty of the wrong kind up shortly.

Kudos to the eating disorders work group on DSM-V

2010-05-30T14:03:00.005-05:00

for deciding not to make obesity a disease in the next edition of the Diagnostic and Statistical Manual of Mental Disorders.

This decision has significant ramifications for how docs treat and to some extent see obese patients. I'm a big proponent of changing the dialogue around obesity from a discussion of weight to a discussion of health. The two are not synonymous. I'm also hoping this will stop bariatric surgeons from marketing their surgeries as eating-disorder treatments, for instance.

The group also recommended changing criteria for anorexia and bulimia:
• Now patients must weight 85% of ideal body weight or less for a diagnosis of anorexia; in future, if the changes go through, the criterion will be "restriction of energy intake [leading to] markedly low weight." This rightly shifts the emphasis from the rigid weight characteristic to a pattern of eating and relationship with food. Now insurance companies will have a harder time cutting people off from treatment once they hit 86% of ideal body weight.
• Loss of menstrual period is no longer one of the criteria for anorexia. Some women never lose their period, no matter how thin they get; others keep menstruating even at very low weights.
• Bulimia will be diagnosable with purging episodes of once a week; right now, the criterion is two episodes a week.
• Binge eating is likely to become a diagnosable eating disorder.

New film: Fat

2010-05-15T16:21:00.001-05:00

A filmmaker named Jennifer Jonassen sent me a link to this trailer for a new documentary, FAT, due out later this year. I think it looks pretty interesting. What do you think?

"You're so fat!"

2010-05-01T16:20:00.003-05:00

The car was a beat-up sedan crammed with college kids--guys--who had clearly started their Saturday night partying on Saturday afternoon. My husband and I were out for a short three-mile bike ride. I heard the guys yelling and carrying on from a block away, and I knew they would yell something at me. And they did.

"You're so fat!"

As I pulled up alongside my husband, he asked, "What did they say?" When I told him, his jaw dropped.

"I can't believe they would say something like that!" he fumed.

I could. And as I told him, it didn't bother me all that much. I'm used to it. Guys have been yelling things at me since I was 15. Like any woman, I've learned to tune it out. It's a power trip, a form of misogyny, a reminder that women are vulnerable to men in a variety of ways.

Still, I thought about it all the way home. It reminded me of the way boys at my junior high school used to drop pennies on the ground, and yell "Kike!" at anyone who picked one up. And with that recollection, I realized viscerally, profoundly, and in a deeply emotional way that what those guys in the car were doing has a name: hate speech.

And although I've been thinking and writing and talking about this subject for years, I think this was the first time I truly got it in a fundamental way. And that is something I'll be thinking about for weeks to come.

Book trailer

2010-04-27T19:04:00.002-05:00

A very talented student at Newhouse, Shelby Hadden, created this trailer for my forthcoming memoir, BRAVE GIRL EATING: A FAMILY'S STRUGGLE WITH ANOREXIA. Isn't technology great?

Let me know what you think.

One more reason NOT to get bariatric surgery

2010-04-24T06:06:00.003-05:00

Bariatric surgery--the practice of deliberately mutiliating the gastric anatomy in order to lose weight--is being pushed harder than ever these days. The latest claim: it cures Type II diabetes instantly.

Not so fast. Apparently the issue is more nuanced than that. Researchers at the University of Washington recently found that people whose fasting blood glucose levels came down after having the surgery were still spiking diabetes-level glucose levels after meals.

The money quote:

"I don't think the procedure cures whatever it is that's causing diabetes in the first place," said Arthur Chernoff, MD, chair of endocrinology at Albert Einstein Medical Center in Philadelphia, who wasn't involved in the study.

SHocking, isn't it? Fat may not be the only cause of diabetes.

In fact, the weight-diabetes link is one of doctors' strongest arguments against fat acceptance and health at every size. Bariatric surgery is very serious business--and I mean that in both senses of the word. It's a multimillion-dollar industry based on the premise that it's a good idea to take out part of your guts--forever. Once you've had the surgery, your body is unable to process nutrients the way it used to. You may or may not become thin (some people lose weight only to regain it after); you may or may not experience some of the serious complications of the surgery; you will be permanently malnourished.

And now you may not have an instant cure for Type II diabetes after all. Because the equation may be a bit more complex than fat = bad, thin = good.

Bravo to Gawker

2010-04-19T16:30:00.003-05:00

That sound you hear? It's me clapping for this tell-it-like-it-is piece from Gawker, which deftly skewers the mainstream media's not-so-hidden obsession with thinness.

My favorite quote:
The purpose of working out is get in shape. Not to get "thin." To be in shape, for the average person, connotes being healthy, and improving on the basic elements of one's own fitness: muscular strength, endurance, cardiovascular, flexibility, etc. . . . designing a workout and nutrition program with the goal of being thin will almost certainly ensure that you cannot achieve a high level of fitness; you would eat a low-calorie diet, thereby robbing yourself of muscular gains.

Note that I deleted a sentence or two in here. Even Gawker falls prey to the knee-jerk obesity-is-bad syndrome. (We really have to have a chat about that, Nick Denton.) But it's not so easy calling out the Gray Lady herself on the assumptions and obsession with thinness. So kudos to Gawker, and Hamilton Nolan, who wrote this post. Let 'em know what you think.

Fat and thin: It's all in your brain?

2010-04-16T12:25:00.006-05:00

A new report from Brigham Young University suggests that women may be hardwired to worry about body image. Using functional MRI scanners, which record which parts of the brain light up while it's engaged in a task, researchers have discovered that women's brains react differently than men's to images of fat and thin. Study subjects, who were all thin, passed a screening test for eating disorders and so were presumed to have no overwhelming body image concerns.

When women were shown images of overweight women and told to imagine that someone commented that they looked like the woman in the image, a part of their brains that engages in self-reflection lit up. When looking at the images, says Mark Allen, a neuroscientist at BU, "women are actually engaging in an evaluation of who they are and whether they are worthwhile as a person. Even though women might claim to be well adjusted and not care about body issues, subconsciously they might care."

But couldn't this be the result of the overwhelming socialization American women experience on the subject of fat? Would the brains of women in a different culture--a culture that didn't put so much value on the thin ideal for women—light up the same way?

I'm not a neuroscientist, but I wonder if this study is flawed. Or maybe I simply don't want to accept that there's a biological limit to self-acceptance on this issue.

I'd love to hear what you think.

Britney does Photoshopping

2010-04-13T18:13:00.002-05:00

Kudos to Britney Spears, of all people, for releasing some before and after photos of herself--before and after airbrushing and photoshopping, that is. She's the latest in a trickle of celebrities doing this. It's a commendable effort, even if, as Jezebel rightly points out, the before images are still unrealistic, thanks to makeup, lighting, and other props ordinary women don't have when they look in the mirror.

Still, it's a start, a small stone rippling the surface of the unattainable thin ideal. Me, I'm hoping for the rockslide. Any day now.

Health Care for the Obese

2010-04-07T06:23:00.003-05:00

A new study published today reports that overweight and obese patients get the same or better quality of health care than "normal" weight patients.

Researchers at the University of Pennsylvania say they looked at quality of care across eight performance measures among Medicare and VA patients, and found no difference in the kinds of treatments doctors prescribed for obese and non-obese patients.

According to a s tory on MedPage Today, "Performance measures included diabetes care management (such as lipid and HbA1c monitoring and eye tests), pneumococcal vaccination, influenza vaccination, screening mammography, colorectal cancer screening, and cervical cancer screening." The story goes on to quote one of the researchers commenting that while doctors do "harbor negative attitudes" toward heavier patients, that prejudice doesn't affect the quality of care delivered.

I think this is a pretty grandiose conclusion to draw from such a limited study, and the researchers themselves cautioned against extrapolating these results too broadly. To me, the study raises some interesting questions: Are doctors more tolerant of overweight vets and/or poorer patients? Is "quality of care" strictly a function of which treatments are recommended?

I don't think so. I wonder what the patients would have to say about the quality of care they received--not just the treatment recommendations (which are of course important) but the relationship they had with their docs, and how it affects their long-term care. I wonder whether these two populations typically have long-term relationships with the same doctor, or whether they often see a revolving cast of medical providers, and whether that might make doctors react differently to them than to patients they see regularly.

Thoughts?

Warning: The Images You Are About to See May Be Damaging to Your Health

2010-04-06T06:03:00.007-05:00

I'm a big fan of Jezebel, but I think they've got it wrong this morning. In a post discussing a recent editorial in the Daily Mail by grieving mother Rosalind Ponomarenko-Jones, whose 19-year-old daughter died of anorexia, Margaret Hartmann argues against the notion of labeling photos of celebrity "twiglets" when they get too thin.

Ponomarenko-Jones argues against the current appearance-driven culture, which calls out celebrities not for achievements but for appearance. And "calls out" is the right expression, since we're all familiar with the standard scary-skinny-celebrity story these days: Publish a photo of a woman so emaciated that it's painful to look at her, along with a headline that screams a fake concern for her well-being. The whole exercise feels prurient and voyeuristic.

Hartmann centers her argument on the logistics and legality of the question: How would we determine when a celeb is "too thin"? How would we know when to label an image and when not to? It's a valid point. And before commenters jump on me for this, I acknowledge that you can't tell whether someone has an eating disorder just by looking at her. Some people are naturally skinny, and there are other reasons (other illnesses) for gauntness.

But Ponomarenko-Jones has the moral high ground here, and I wish there were a way to honor the spirit of her request. Because we (and by "we" I mean the media) don't go around publishing photos of, say, recent cancer victims, who may be every bit as scarily skinny as an actress in the grip of anorexia. Yet magazines and websites are full of images of "twiglets," young women so thin you can see the shape of their femurs. Why is it OK to publish these images and not, say, images of Farah Fawcett as she lay dying of cancer?

It comes down to our blindness to eating disorders as "real" diseases. We would cringe at the idea of violating Fawcett's privacy in that way. Yet the young celebrities who walk so scary-skinny among us are dying of an illness, too, an illness that will kill them as surely as cancer killed Fawcett. The difference is that with treatment, many of these women can recover; for Fawcett and many other cancer victims, alas, treatment did not save their lives.

And of course treatment won't always help with eating disorders, either. But the point here is that instead of parading these images as models for women--whether this is openly acknowledged or not--we should label them for what they are: images of the gravely ill, who are struggling with their own terrible reality and heart-breaking health battles.

Jezebel got it wrong. The real shanda (as my grandmother would have said) is that we pretend there's no such thing as too thin.

Conference in Chicago--register now!

2010-04-02T15:38:00.004-05:00

In just over two weeks Maudsley Parents will sponsor its second conference on eating disorders--this time in Chicago. This one-day conference, aimed at parents, therapists, and researchers, features some of the best thinkers on eating disorders in the country--including Dr. Daniel le Grange and Dr. Walter Kaye—plus a panel of parents who will talk frankly about what they know about combating their children's eating disorders.

It's going to be a fabulous event. I'll be there, along with my two partners in crime from Maudsley Parents--Jane Cawley and Ann Farine. We've worked hard to keep it affordable so everyone who wants to come can manage it.

For more information or to register, click here. We'd love to see you in Chicago!

Book Giveaway: 100 Questions & Answers About Anorexia Nervosa

2010-03-22T06:10:00.005-05:00

Dr. Sari Shepphird is one of my favorite "experts." Shepphird, a clinical psychologist from Los Angeles who specializes in treating eating disorders, has a new book out, 100 Questions & Answers About Anorexia Nervosa. The book tackles the complex and confusing subject of eating disorders by posing and answering questions like "Are athletes at greater risk for developing anorexia and eating disorders" and "How do I know if I have a healthy body image?" The book is written for people with anorexia, their friends and families. I admire its clear, practical approach, and think it will be of great help to many.

And I've got a copy to give away! If you'd like to enter the drawing for a free copy of Dr. Shepphird's new book, leave a comment on this post telling me why you're interested in reading it. I'll draw names at random next Monday, March 29.

Good luck!

A troll among many trolls

2010-03-16T11:48:00.003-05:00

I don't normally bother with trolls, but this one sent me an email to my work address that is so vile, I have to share it here with all of you.

Barry, I suspect you are what I think of as a self-loather. Maybe you were once fat. Maybe you're fat now. Maybe you're deathly afraid you will be fat in the future.

Personally, I love how you toss aside research in favor of your own baseless and warped opinions. That Barry, he sure knows better than those high-falutin' doctors who actually research this stuff!

Since you think shame is a good health-care strategy, I'll take your idea a step further and see if shame is a good strategy for curing haters like you. Probably not, alas.

I hope my readers will respond to you in the same spirit in which you wrote to me.

I was mystified and angered by your article in the Times today. Are you actually arguing that obesity is a healthy lifestyle? Are you really saying that fat people have no control over their food intake and amount of exercise? Eating too much is nothing to be proud of, just as drinking too much alcohol is nothing to celebrate. You are lying to yourself if you think you are not shoving far too many calories into your mouth. You're fat because you can't control yourself--it's that simple.

The reason we stigmatize obesity is because it really is a choice, unlike skin color, ethnicity and the religion you were raised in. Obesity is a signal to others that this fat person is living an important part of his/her life totally out of control. It signals a lack of self-discipline and a warped sense of self-worth. Your position on this means means you're proud of your lack of control about how much, and what, you eat. It's delusional to be proud and pleased that you are out of breath when you climb stairs, that you are heading for a horrible old age--if you live that long, that making love to your partner is a problem instead of a happy event, and that you can't perform simple tasks from properly wiping your ass on the toilet to picking up an earring you've dropped.

Delusional: For example, you state that the emotional stress of the prejudice against fat people causes the health issues that result from obesity. That is not science, that is nonsense. We know stress can be a contributing factor to poor health, but you're trying to blame others for the conditions you create by eating too much. Reminds me of alcoholics saying they drink too much because of all the pressure on them to stop drinking.

On the one hand you blame doctors for relating to obese people differently than normal weight folks because, as you say, doctors believe fat patients won't follow orders, won't show up for appointments etc. Then later in your article you say fat people don't show up for doctor appointments because they feel bad about themselves and worry about how doctors will relate to them. Doctors know from experience that fat people miss appointments and can't or won't take care of their own health. Of course they relate differently to people like you who disdain main stream medical advice.

When Lincoln University tried to help fat kids get well and avoid incipient heart and other diseases, you condemn them for their efforts. What you fail to understand is that your stance actually kills people by making gluttony and self abuse through food a good choice, a choice to be proud of. What you are doing diminishes the real harm of prejudice which punishes innocent people for the color of their skin or their ethnicity--things they can't and should not want to change.

But obesity is a lifestyle choice, like smoking and alcoholism, a self-destructive lifestyle choice that harms the people who choose to follow that course. Anyone can get thinner and improve their overall health. It is not easy but rarely are the important life choices easy. That doesn't make your choice a virtue. It is difficult to diet and exercise on a regular basis and change your attitude about stuffing as much food as you can into your face. We've all heard the reasons people live your way, and none of them are good, abuse as a child, the comfort derived from eating lots of fatty creamy things, the hit of sugar, the bad habits of a deprived upbringing blah blah blah. We rightfully despise drunks who abuse themselves and others, ruin careers and the lives of those who love them. Similarly obese people are wearing a big sign that says "it's all about me and screw you who object to my overeating, it's costs to society, it's bad example to young people, it's strong signal that I'm out of control. I do it because it feels good and I'm proud of that." This is called selfish and irresponsible--nothing to be proud of.

Think about the damage your article has done. Making a virtue out of a lifestyle that any scientist, medical person or just plain educated folks know is harmful. Shame on you.
Barry XXXX
NY

PLEASE NOTE: THIS THREAD IS NOW CLOSED.

The stigma of obesity

2010-03-15T15:32:00.004-05:00

I'm delighted that the New York Times has run this piece, even though they cut the fabulous Marilyn Wann from my final draft.

Let me know what you think. And if you're feeling brave, venture on over to the New York Times' blog discussion of it. It's a stunning example of how deeply ingrained fat stigma is in our culture. Sheesh.

And a big welcome to Jezzies who land here. Love the photo of Gabby that ran with the post today.

Protest in D.C. today

2010-03-09T06:53:00.003-06:00

If you're in Washington, D.C., today, check out this protest against the insurance industry. Activists plan to "arrest" health insurance execs who are there for a meeting, and hold a rally afterward.

The idea behind the event, according to Gerald McEntee, president of the American Federation of State, County, and Municipal Employees (AFSCME), is "to expose the high crimes and misdemeanors perpetuated by the insurance industry time after time and year after year, and we are totally sick of it. We're going to crash their party and put an end to its injustice."

I'm with you in spirit!

The U.K. tackles body image issues

2010-03-05T16:02:00.007-06:00

Kudos to the Royal College of Psychiatrists across the pond for taking on the thorny issue of media and body image in a powerful way.

The U.K. group just issued a statement admonishing the media for their damaging portrayal of eating disorders. That's good, and it goes along with similar statements made recently by several U. S. groups. Raising awareness on both sides of the pond--excellent work.

The RCC's gone a step further, though, calling for a "new editorial code" that would end the promotion of the unattainable thin ideal in the media. This is a bold step, and I'm going to be following developments closely on this subject.

The RCC identified three main areas of concern (and I'm quoting here from its press release, as you can no doubt tell from the Anglicized spelling):

Visual imagery: Preteen or underweight models are used by the media and advertising companies to promote a thin body ideal, and airbrushing and digital enhancement is widely used to portray physical perfection that is unattainable in real life.

Unbalanced articles : Many magazine articles give advice on dieting without giving information about the long-term effectiveness of diets and the dangers of extreme dieting. ‘Body critical’ articles also target celebrities for being overweight, underweight or physically imperfect, which normalises body criticism and can make people dissatisfied with their own bodies.

Inaccurate portrayal of eating disorders: Many articles ‘glamorise’ weight loss and portray eating disorders as mild disorders or personal weaknesses, rather than serious mental illnesses requiring specialist treatment.

I'm expecting cries of First Amendment foul on this side of the pond. It raises an interesting dilemma for me, as both a magazine journalist (and professor of magazine journalism) and an eating disorders advocate. Is censorship ever a good idea? How about self-censorship, which I think is what the British shrinks are suggesting?

My journalism colleagues will no doubt want to throw me off the island for saying this, but I'm all for some kind of self-censorship in this case. No journalistic standards will be violated if, for instance, magazines ran images of beautiful 20-year-old American models instead of emaciated Russian preteens with preternaturally pouty lips. In fact, I could argue that in the best possible tradition of journalism, magazines have a responsibility to tell both sides of the story: Instead of blaring the trumpets of weight loss at any cost, how about stories that encourage women to accept and love themselves as they are? I'm not even gonna mention the kind of cognitive dissonance that comes from Photoshopping the hell out of Kelly Clarkson on the cover and then running a feature quoting her as saying she loves her body the way it is and doesn't feel the need to diet herself into oblivion. I'm not even going to mention the magazine that did this (cough, rhymes with elf).

When I pitched a story on self-acceptance and body image recently to a magazine that shall not be named (cough, rhymes with wealth), I was told by my editor, rather sadly, that it would never fly.

Maybe when pigs grow wings.

**Thanks to one of my students, Courtney Egleston, for posting this story originally on the Newhouse magazine feed.

Jezebel investigates MeMe Roth!

2010-02-25T08:40:00.002-06:00

Check out this awesome post by Jenna over at Jezebel, who as far as I can tell is the only journalist who's actually bothered to investigate Roth's pseudo (cough fake) credentials for her ridiculous one-woman anti-obesity campaign.

As a professor of journalism and writer for mainstream media outlets, I'd love to know why no one else has even questioned Roth's patently false claims and unsupported stance. How about Nightline, which pitted Roth and a chick named Kim Bensen against Marianne Kirby and Crystal Renn in this "faceoff" questioning "Is it OK to be fat?"

I can't help but think this is a) an example of how sloppy some journalists are getting, and b) a function of the widespread fatphobia washing through the culture.

Either way, kudos to Jezebel for doing some actual reporting. And, of course, presenting that reportage with the requisite levels of snark and sarcasm.

The Woman at the Y, part 4

2010-02-21T15:48:00.005-06:00

She was back again. The woman at the Y. I thought I was ready. I'd talked to myself about it. I'd told myself, It's her business, it's her life, I don't know her story, and anyway, there's nothing I can do. So when she took up a position right toward the back of the room this morning, I made myself look away from her in the mirror. I did OK.

But five minutes later, I looked at the mirror and she had somehow moved up in the class. She was now directly behind me, close enough to once more see the shape of her thigh bones through her pants, see the strained and straining look on her face. When the song ended I moved across the room, to a spot where I couldn't easily see her. I thought I was doing OK.

And she took off her shirt.

Understand, this is not a class where people take off their shirts or exercise in their sports bras. I've never seen anyone else do that. Not that there's anything offensive about the idea of working out in a sports bra; it's just not the culture of this particular class. So her action would have been startling no matter who she was or what she looked like.

Now everyone could see the shape of every rib, count the knobs of her spine, consider the impossibly small diameter of her waist.

I fled. I ran out of the room clutching my water bottle and sat in the bathroom of the Y and cried.

I'm sure at this point that she knows that her presence disturbs me. As a friend later said, it's as if she's a specter, haunting me. As if I needed haunting. As if I needed reminding of everything anorexia has taken from the people I love and care about.

I won't be going back to that class.

Comments have been disabled on this blog post only.

Why Dick Cavett needs a muzzle. Or maybe a gag.

2010-02-13T20:58:00.008-06:00

I used to like Dick Cavett. Of all the talk show hosts, he was the one known for his erudition, his intellectual streak. Johnny was the funny one, but Dick was the insightful interviewer, the one who came up with the best questions, whose show made you think.

I haven't been a fan of Dick's in a while, ever since he wrote this truly obnoxious blog post on obesity. Cavett's not the only painfully thin celebrity to weigh in (ha ha) on the subject, and he won't be the last. But his blog post seemed especially egregious to me, maybe because he wasn't responding to a current event, or an interviewer's question. He was just flying his fatphobic flag, loud and proud. By using words "heavily larded," "a herd of heifers," "the size of the Hindenburg," and other choice descriptors, Cavett showed off not only his vocabulary but his jejune perspective. (No, Dick, you're not the only one who knows fancy words.)

I thought I was over Dick Cavett. I really did. It's hard to stay pissed off at a washed-up ex-talk-show-host who's got nothing better to do than vilify people based on their appearance. Then he ticked me off all over again with a quote in this week's New Yorker magazine, in a piece by Ben McGrath on an odd little throwback of a recruitment video recently released by Yale.

McGrath quotes various Yale alums on the pros and cons of the video. Their comments are informative and amusing. That is, until we get to Cavett, who says, "“I wonder if it really was made in America, because there are no fatties.”

Really, Dick? That's your reaction? That the video features "no fatties"? What does that have to do with the subject at hand?

It seems that Cavett just can't put a lid on it; he's got to inject a little fatphobia into every conversation in print. Mercifully, there aren't too many of those, because, after all, he hasn't actually done anything worth mentioning in about 25 years. Maybe he's trying to line himself up a reality show. Maybe he wants to replace Howard Stern. Or maybe he's so obsessed with the subject of fat people that he literally can't help himself.

In which case, Dick, let me give you a few words of advice: Shut up already. You may have a high IQ, but your comments illustrate your ignorance, your prejudice, and your inherent lack of decency and kindness.

Come to think of it, maybe Rush Limbaugh has a co-host spot. Dick Cavett would be perfect for the job.

Ditching the concept of "refusal"

2010-02-11T16:20:00.003-06:00

The editors of the venerable Diagnostic and Statistical Manual of Mental Disorders, otherwise known as DSM, have just released proposed revisions for the fifth edition of the book, due out in 2013. And WOO-HOO! They've taken out the word refusal in their criteria for anorexia nervosa.

That word has always bugged the crap out of me. It embodies everything I've come to dislike and distrust about conventional eating disorders treatment. It assumes that the person with anorexia is making a choice--a conscious choice--to not eat. It reinforces Hilde Bruch's characterization of anorexia and the people who suffer from it and the whole psychodynamic theory of AN--a theory that has absolutely no basis in scientific evidence or fact. A theory that has kept ED treatment in the 18th century, in my opinion, and condemned sufferers to years of ineffective treatment and torment.

So three cheers to the editors. I hope their proposed revisions make the final cut.

NEDA Walk in San Diego

2010-02-11T12:23:00.003-06:00

You don't have to be in San Diego to support the first annual San Diego NEDA walk, which will be held on February 21. The walk is being hosted by the University of California San Diego's Eating Disorders Program--the same folks who run a five-day intensive outpatient program for families getting started with family-based treatment for anorexia or bulimia.

Sign up online to sponsor one or more walkers on UCSD's team, which includes Walter Kaye, Roxanne Rockwell, and Bridget Whitlow. Go, team!

A word about civility

2010-02-01T11:35:00.002-06:00

Hey folks--

It should be clear by now that I'm not going to post comments that are rude, spiteful, mean, or abusive. I make an effort to be positive and constructive in my posts and when I respond to comments. I hold you to the same standards, or I won't be allowing your comments.

We don't have to agree. We do have to have a civil dialogue.

Frankly, my college writing students are far better at the whole constructive criticism thing than some of my anonymous commenters.

And you know what? It's hurtful. And hurt just breeds hurt.

So please, do yourself a favor, and either grow up or go comment on someone else's blog.

The Woman at the Y, Part 3

2010-01-31T10:57:00.003-06:00

She was there again, the woman who comes to the Y sometimes. The woman who is so painfully thin I can see the shape of her femurs through several layers of clothes. The woman whose gaze is inward, whose face has the haunted look I recognize.

This time I tried to engage her before class--to reach out. I said hello. She looked at me and turned away. I haven't seen her talk to anyone, so maybe this wasn't surprising.

Usually she stays at the back of the class, but not today. Today she took a spot front and center, right behind the instructor and in front of the mirror. The harder the workout got, the more broadly she smiled at herself in the mirror. The more she smiled, the more sick I felt.

In the end I had to leave. I grabbed my coat in the middle of a song and ran out of the room, into a bathroom, where I cried and cried. I can't celebrate the joy of moving to music I love when I'm looking at her and imagining how many calories she's burning, how little she eats. When I know that she looks in the mirror and sees something completely different from what I see.

I don't know what to do, truly.

NAAFA takes on Michelle Obama's crusade against childhood obesity

2010-01-29T16:04:00.002-06:00

I wouldn't normally repost a press release. But this one from the National Association to Advance Fat Acceptance is so well-researched and concisely effective that I can't resist.

Repeat after me, everyone: Shame is not a health-care strategy.

Enjoy.

NAAFA Challenges the First Lady

For Immediate Release
January 29, 2010

Oakland, CA – First Lady Michele Obama has recently announced her intention to focus on childhood obesity prevention. NAAFA encourages the First Lady to consider all the research before taking action and supporting any program that may do more harm than good.

Mrs. Obama, please explore and consider the following:

• When important figures such as parents, teachers and peers in children's social environment endorse a preference for thinness and place an importance on weight control, this can contribute to body dissatisfaction, dieting, low self-esteem and weight bias among children and adolescents (Davison & Birch, 2001; Davison & Birch, 2004; Dohnt & Tiggemann, 2006; Smolak, Levine, & Schermer, 1999).

• The stigmatization of large children has increased by 40% over the last 30 years (Latner & Stunkard, 2003).

• Many drugs presently being prescribed to children cause weight gain. There was a 40 fold increase in bi-polar diagnoses in children between 1994 and 2003. 90.6% of youth received a psychotropic medication during bipolar disorder visits. For many, mood stabilizers, antipsychotics, and antidepressants were also prescribed. (Arch Gen Psychiatr,. 2007)

• Prescribing dieting is, in effect, prescribing weight cycling, and many people will be fatter in the long run (Mann, 2007).

• Weight-control practices among young people reliably predict greater weight gain, regardless of baseline weight, than that of adolescents who do not engage in such practices (Neumark-Sztainer et al., 2006).

• Based on results from a population-based, longitudinal study with 2,500 teens, Neumark-Sztainer and colleagues at the University of Minnesota (2006) concluded that to prevent obesity and eating disorders, the focus needs to be on health much more than weight. The more weight per se is talked about, the more likely teens are to adopt dangerous dieting behaviors.

• A 2006 study from UCLA suggests our media and cultural obsession with achieving a certain weight does little or no good and may actually undermine motivation to adopt exercise and other healthy lifestyle habits.

• The National Center for Health Statistics, part of the Centers for Disease Control and Prevention indicated in 2008 that childhood obesity has leveled off.

NAAFA urges the First Lady to:

• Partner with us and our many resources in the scientific and healthcare communities to examine this issue. Fat children are already the targets of merciless bullying. NAAFA urges Mrs. Obama not to support any programs that would create a pervasive bias against fat children.

• Consider Guidelines for Childhood Obesity Prevention Programs found at: http://www.aedweb.org/media/Guidelines.cfm Childhood School Plans at http://www.healthyweight.net/schools.htm and Guidelines for Children at http://www.healthyweight.net/children.htm

• Support the Health at Every Size (HAES) tenets which state that healthy habits are good for EVERYONE, no matter what their size. Eat healthy, nutritious foods and enjoy occasional treats. Pay attention to your natural hunger and satiety cues. Move your body in ways that feel good rather than exercise focused solely on weight loss.

"Obesity has a strong genetic component that is expressed in environments that foster sedentary activity and eating an energy dense diet", stated Joanne Ikeda, Nutritionist Emeritus, University of California Berkeley, "Therefore, we encourage First Lady Michelle Obama to promote environmental changes in school settings that support enjoyable physical activity and consumption of a wide variety of nutritious, appetizing foods."

This issue is about the critical need to create environments in which children and adolescents do not feel shame or guilt about their bodies but, rather, are motivated to enjoy healthful eating and active living habits regardless of their body size or shape.

Founded in 1969, NAAFA is a non-profit human rights organization dedicated to improving the quality of life for fat people. NAAFA works to eliminate discrimination based on body size and provide fat people with the tools for self-empowerment through public education, advocacy, and member support.

On the web:
http://www.naafa.org

News flash: A little "extra" weight can be a good thing

2010-01-29T09:30:00.003-06:00

Especially if you're over 70, say researchers at the Western Australian Center for Health and Aging.

A recent study shows that normal-weight and obese patients over 70 had slightly higher levels of mortality than those whose BMIs put them into the overweight category--BMIs of 25 to 29.

In an article in the Journal of the American Geriatrics Society, the researchers said, "These results lend further credence to claims that the body mass index [BMI] thresholds for overweight and obese are overly restrictive for older people."

Makes sense to me--that "extra weight" is what Ellyn Satter describes as "nutritional resources." Food is fuel, folks. Your body needs food not just to power itself but to fuel resilience, especially as we get older.

Now I want to see them study this same notion in 60-year-olds. I'm curious about what the results might show.