"Fitnessgrams" for kids

My 11-year-old daughter's report card came in the mail today. Along with the usual list of academic subjects and grades came another piece of paper with a big orange bar at the top. In blue blue letters it read FITNESSGRAM. Below was a graph of how my daughter had performed on a series of fitness tests, including a one-mile run, abdominal curl-ups, trunk lifts, push-ups, and flexibility. Then there was another little box labeled "Body Mass Index," showing her past and current BMIs plotted against a bar graph. Her scores were in the green "healthy fitness zone." To the right was a large red area--danger! fatsos coming!--labeled "Needs improvement." That's where your bar graph ends up if your BMI is "too high." To the left was a tiny red box labeled "very low," which is, I suppose, where your bar graph ends up if you're anorexic.

I guess this is supposed to be a cute, non-threatening way of communicating with parents, a kind of casual, unofficial, "Say, did you know your kid's in great shape?" or "Hey, by the way, your kid's kinda fat!"

This is insulting on any number of levels, of course, but let's just pick one: the suggestion that it's better to be too skinny than too fat, which as we know is not supported by any actual science.** Why isn't the "too skinny" area labeled something like "needs medical attention now!"? Why isn't the "too fat" area labeled "plenty of nutritional reserves!"?

My daughter was more upset about the fake activity pyramid on the back of the fitnessgram, modeled after that most famous of irrelevancies, the USDA food pyramid. At the bottom, the widest section was labeled "lifestyle activity," and it listed walking, biking, skateboarding, housework, yardwork, dancing, and playing active games. The next level held two smaller squares labeled aerobic activity and aerobic sports. One level up, another two squares were labeled muscular activity and flexibility activity. The smallest section, the point of the pyramid, was labeled "rest," and it included schoolwork, homework, reading, computer games, TV, videos, eating, resting, and sleeping.

Clearly these are the things you're supposed to do as little of as possible. My daughter was outraged. "I wonder what the teachers would think about this!" she cried. "You're not supposed to read?"

Imagine boot camp. Then imagine a sergeant from boot camp running the schools. "You there, cadet, stop wasting time with your nose in a book and give me 50 on the floor!" Never mind the fact that kids are supposed to be developing their intellectual capabilities at this (and every) age; in the new Fitness World, only activities that burn calories are sanctioned. Even by schools.

I feel like we're living in a Kurt Vonnegut story. And it's only gonna get worse.


** Calorie reduction (CR) nutcases notwithstanding.

Why dieting is the ultimate health risk

Big kudos to Sandy Szwarc, whose most recent post looks at how the American Heart Association's "heart-healthy" diet recommendations don't actually add up to better health or longer lives for women.

Eating healthy, in other words, doesn't protect you from heart disease. (We're talking about women who aren't sick; the statistics are different for those who already have heart disease.) And eating "not-healthy" doesn't put you at higher risk--at least, no studies have been able to show a cause and effect relationship.

In fact, all "eating healthy" (read: dieting) does, as we know, is make you fatter by messing up your metabolism with the deprivation-and-binge cycle. So dieting itself is a risk factor for obesity.

Obesity, it turns out, is a risk factor for diabetes, but not much else. Fat people actually do better after heart attacks than thin people. Older people who are fat live longer than their skinny peers.

Another thing dieting does is trigger eating disorders in those who are susceptible. Once more, dieting itself is a risk factor for anorexia, a serious illness that kills up to 20% of those who suffer from it.

Oh yeah, it does one more thing: Make money for the multi-billion-dollar weight loss industry, for the bariatric surgeons, and for the obesity researchers. Cui bono, baby?

So forget the war on obesity, which is as ill-conceived and well-funded as the war in Iraq. I think we need a war on dieting.

**This post is dedicated to the memory of my dear friend Marilyn "Mimi" Orner, who founded the Anti-Anorexia/Bulimia/Dieting Project. She was an advocate of size acceptance, a survivor of anorexia, and a powerful inspiration to a generation of young women. She died of ovarian cancer in 2000 but has not been forgotten. You still rock, Mimi!

How can you tell if your child is developing an eating disorder?

Go here to listen to my radio essay on the subject, which aired today on "To the Best of Our Knowledge." The essay aired as part of the show dated 6/17/07.

Fat--it's all in your head

At least according to this editorial in the American Journal of Psychiatry, exploring the question of whether to make obesity a brain disorder in DSM-V.

Of course, it's not really clear what exactly they mean by brain disorder. Anorexia and bulimia are listed in DSM-IV as brain disorders, sorta, and I have to say, I'm not sure what that means, either. Insurers still treat them as mental health issues rather than biologically based illnesses, and use that as a way to skive off covering them (at least in beknighted states like Wisconsin, which have no mental healthy parity laws).

It depends what the rationale is here, really. What we now know about eating disorders like anorexia is that some people are genetically and biologically predisposed to them, and that environment seems to play some kind of role in triggering those who are susceptible. Maybe that's true for obesity. That makes more sense to me than suggesting that all so-called obese people are compulsive eaters, which we know ain't true. Yo-yo dieting might be the environmental trigger, resetting the metabolism over time in ways that result in obesity.

But if an entry in DSM-V is going to result in more stigma attached to being obesity, I think we should say no thanks.

What do you think?

The obesity paradox

Thanks to fat fu for pointing me toward this article on the so-called obesity paradox. It reads like something straight out of Jonathan Swift. Or Lenny Bruce. You can just hear it, can't you?

Judge: You say that fat people live longer after heart attacks? Impossible.
D.A.: I know, your honor. Fat kills! Most of the time.
Judge: What's your evidence, counsel?
D.A.: Everybody knows it's bad to be fat!
Defense: Objection! "Everybody knows" is not admissible in court.
Judge: Overruled. In this case, no evidence is necessary. [rises from seat, points accusing finger at defense counsel] You're not eligible to serve as counsel in this case, Counsel, because . . . you're FAT!

And so on.

The real obesity paradox, of course, is our culture's blind and stubborn insistence on vilifying and demonizing fat people and fat, in the face of any and all evidence to the contrary.

Fat kills. Except when it doesn't.

Deaths from coronary artery disease in the U.S. went down by half between 1980 and 2000, and researchers at the University of Liverpool attribute this to positive lifestyle changes and better treatments.

Now for the bad news: Those same researchers go on to say, on no cited evidence, that the number of deaths would have been reduced even further had it not been for the rise in obesity and diabetes.

How do they know this? Well, they don't, actually. One researcher is quoted as saying, "The increase in obesity and diabetes are a wakeup call. They reflect the increasing consumption of large helpings of junk food."

Hmmm. So deaths from heart disease have decreased during the same time that rate of obesity have increased, yet obesity is still to blame. That's what I call having it both ways.

An epidemiologist could look at the same information and come to the opposite conclusion: That obesity has a protective effect when it comes to death from heart disease.

Seems like more of the same fat-is-evil ranting to me, liberally laced with assumptions and a heaping helping of bias. Mmm, mmm.

Another reason to look beyond weight and BMI

The New York Times reports the results of a study showing that young women who weigh enough to menstruate may still be eating too little to be healthy. Researchers at Ohio University found that bone formation, which is critical in adolescence, may not be taking place even if women get regular periods.

This is relevant because doctors so often use menstruation as a marker of health among those recovering from anorexia. But it's clearly not the criterion to live or die by.

Here's the money quote, to my mind: “Regular menstrual cycles do not reliably indicate that they are eating enough for what they’re expending,” Dr. Loucks said. Read more about it here.

Sandy Szwarc does it again

This morning I read the following sentence in Sandy Szwarc's most recent post in her Junkfood Science blog:

"Far more young people are dying from anorexia than . . . from being fat."

Tears sprang to my eyes. That is exactly right.

The emphasis on "overweight children and teens" clouds the issue for the public and for health professionals. So long as doctors and the rest of us are so terrified of being fat, and of having our children be fat, lethal eating disorders like anorexia and bulimia will be underdiagnosed, mistreated, and poorly researched.

Thank you, Sandy, for putting it so plainly.

Repeat after me: Fat is good

An interesting study crossed my desk this week, from a team of researchers in New York who posed the question, "Does percent body fat predict outcome in anorexia nervosa?"

They looked at a number of factors they thought might contribute to relapse in anorexia recovery, including BMI, leptin levels, waist-to-hip ratio, the subtype of anorexia, and percentage of body fat. Only one--body fat--seemed to affect the rate of relapse. "In recently weight-restored women with anorexia nervosa," they wrote, "lower percent body fat was associated with poor long-term outcome."

We're so used to thinking of fat as the Ultimate Evil, which must be banished at any cost, that news like this can feel downright shocking. Fat can be not just good but essential. Without it our brains don't work very well. We're supposed to have a certain amount of fat in our bodies.

This is important for those in recovery from anorexia, especially people (like my own daughter) who are naturally athletic and build a lot of muscle mass. Nothing wrong with muscles, but you've gotta have fat, too. Lean muscle mass without body fat is associated with relapse. And that's not what anybody wants.

So repeat after me: Fat is necessary for human life. Fat is not evil. Fat can even (dare I say it?) be a Very Good Thing.

Advocacy for what?

I've given a lot of thought to how those of us who have children with eating disorders can model our advocacy efforts after those of other groups. Parents of kids with autism, for instance, have been very effective in pushing for legislation covering treatments and other issues.

The thing is, most people aren't busy arguing about what causes autism in the first place, and they pretty much agree on treatments. Whereas folks in the e.d. world are divided in every possible way.

My friend Laura Collins says she'd like to lock all the e.d. experts in a room until they come to an agreement. Ha!

One of the biggest arguments, of course, is the biology-vs.-psychology one. Both parents and professionals have vested interests in taking one side or the other when it comes to both cause and treatment.

When I imagine trying to bring together a coalition of eating disorders parents and professionals to push for legislation and advocacy, I get a sense of how great the conflicts are. For instance, I don't think individual therapy is useful in treating anorexia, at least not during the active recovery phase, so I'm not sure I would want to push for legislation to cover lots and lots of individual therapy.

In case you couldn't tell, I'm of the biology camp, as in the Minnesota Starvation Study. I don't believe kids "think" their way into eating disorders, and I'm damn sure they don't think their way out of them.

I think what's needed most are more and better treatment studies, like the one Dan Le Grange is doing at University of Chicago. We need to know what the best treatments are for anorexia and bulimia.

What do you think we should be pushing for?

How cliches hurt us

What do the obesity epidemic, anorexia nation, and healthy eating all have in common?

They're all cliches, code phrases created by the media. And by "the media" I mean not only the Gray Lady and the Sly Network but small local newspapers, big national magazines, and--oh, yeah--those of us who write and blog about these subjects.

Each of these code phrases contains layers and levels of meaning that never get unpacked. They're like cue balls careening around a pool table, knocking all the other balls out of their way.

When you read the words "the obesity epidemic," you are, in essence, being told what to think and how to think it when it comes to the issue of overweight in America. The phrase itself shapes the way you think about it. If the language were different--if the issue was framed in another way--you might think about it differently.

And this is where I hold the media, and all of us, accountable for the superficial and slick way these deeply important subjects are framed and discarded. Each time yo say the words "the obesity epidemic," you're validating the notion that the nation is in the grip of a contagious pandemic of overweight. If that's what you truly think, you're all set. (I'd like to argue the point. But that's another post.)

But chances are it's not really what you think or what you mean to say. But each time you use that code phrase, you're buying in to someone else's conception of the dialogue. You're letting yourself be co-opted.

It's hard to unpack these code phrases. It's even harder to go against the mainstream, to question the conventional wisdom, to challenge the status quo. But more and more, I think it's crucial that we do exactly that. So next time you find one of these cliches or code phrases flying out of your mouth or tripping off your fingers, take a minute, or five, to consider what you really think. Then say it in your own words.

I'll start: I think the idea of an obesity epidemic is a sadly unimaginative construct that has little or nothing to do with reality. It's a cover for institutionalized prejudice against overweight people, a trigger for eating disorders, and a big waste of our collective time and energy.

Your turn.

There's a sucker born every minute

As P.T. Barnum is often (mistakenly) quoted as saying, There's a sucker born every minute.* And right now, those suckers are us.

At least, those of us who are rushing out to buy the newest FDA-approved diet pill, Alli.

Let's start with the fact that Alli doesn't actually work. Or rather, it doesn't work quite the way you think it might. Taken before meals, it prevents your body from absorbing the fat in food. But it has another mechanism that isn't being touted quite as enthusiastically. Think Antabuse for fat. If you eat fatty food while you're on this stuff, you are likely to have explosive and uncontrolled bowel movements that "smell like fish oil," according to one website I read. This site cautioned consumers to carry a package of baby wipes and an extra pair of pants while taking Alli. Presumably you need experience this only once before you're frightened out of eating fat. Or out of taking the pill.

Don't bother to take Vitamin E while you're on this stuff, either. Alli is likely to decrease your body's ability to absorb fat-soluble vitamins--E, A, D, and K, along with beta carotene.

As Sandy Szwarc points out in her May 25th blog on the subject, this little pill is getting a great big push from its U.S. distributors, GlaxoSmithKline, playing up the FDA's approval (what in the world were they thinking?) and betting that consumers will pony up two bucks a day for the privilege of taking this pseudomedication. And talk about disingenuous! If this article from the New York Times doesn't make you want to scream, your b.s. detector's not working.

How stupid do they think we are? As stupid as we are, apparently. Thin at any price--even wearing adult diapers or buying a whole new wardrobe of all-black pants? I don't think so.

*(If you can tell me who actually said that quote--no fair using Google to find out--I'll send you a free Mr. Wrong T-shirt.)

Thin at any cost

The most horrifying news story I’ve read this spring wasn’t about terrorism or war but about a hormone called leptin, known for its role in regulating appetite and metabolism. Since its discovery in 1994, leptin has become the holy grail of anti-obesity crusaders, a miraculous substance that could suppress appetite at the source: in the brain. In this society, anything’s better than being fat.

Leptin’s superhero status was enhanced last year when a study in the American Journal of Physiology showed that infant rats who were fed lots of leptin never got fat or developed diabetes, no matter how much fat they ate. The idea, explained one of the study’s researchers, was to change the way the body uses and stores energy. In utero and/or early exposure to leptin apparently makes the body metabolically inefficient—not just for a little while but for good.

This finding made leptin the A-bomb of the War on Fat, at least according to a group of researchers at the University of Buckingham. They’re developing a line of baby foods and formula laced with leptin. The goal: to make children thin for life.

Before you start cheering, remember fen-phen, the miracle drug that was supposed to make people thin? It damaged their hearts, and has inspired thousands of lawsuits, many still ongoing 10 years later.

Remember thalidomide?

Even if leptin-laced formula does what it’s supposed to, even if there are no immediate negative side effects, it’s still a worrisome proposition. The nifty little feedback loop we call metabolism serves us well. Human beings are designed to get hungry and eat. It’s a matter of survival.

Witness what happens when the link between appetite and behavior weakens or breaks. My husband and I watched our 14-year-old daughter nearly starve to death after developing anorexia. For two long years, she never felt hungry. She was hungry, of course; many of the behaviors associated with the illness—obsession with cooking, cutting food into tiny bites, pouring mustard on everything—proclaimed this appetite, despite the fact that she herself didn’t feel hunger pangs. But the connection between her brain and her body had been disrupted by the illness.

For my daughter, recovery from anorexia meant gaining quite a bit of weight. What if she’d been a leptin baby, her metabolism engineered to make weight gain difficult or impossible? No matter how many calories a day we fed her, she might not have survived. Some researchers believe that breakdowns in leptin regulation and processing might be part of what causes anorexia in the first place. Certainly an important step in my daughter’s recovery has been learning to recognize feelings of hunger and fullness again—feelings she would never have access to, if the Birmingham researchers have their way.

As a recent UCLA study showed, 98 percent of diets fail, causing a rebound effect that winds up making people fatter. Ditto the no-fat craze of the 1980s, which may well have something to do with the current rise in obesity.

No matter how well-intentioned, our attempts to micro-manage our metabolisms usually cause more harm than good. Better to teach kids to eat when they’re hungry and stop when they’re full, and to accept the fact that humans come in different shapes and sizes, than to mess up the next generation’s neurochemistry in the name of thinness.

More inspiration from autism advocacy

A reader sent me this link for an inspiring story about success from a group of parents with autistic children and their advocacy work.

What's it gonna take for those of us with children who are eating disordered? What would it take to force insurers to cover e.d. treatments at the same level they cover other biologically based illnesses?

Maybe we each need to pledge to do SOMETHING on the advocacy front when we're able.

Taking a lesson from autism

An article in my local paper got me thinking yesterday. If the autism parents can get their shit together to push for more comprehensive insurance coverage of their kids' illness, why can't we?

Jim Lock himself, one of the gurus of the Maudsley method here in the U.S., once told me that eating disorders parents should model ourselves on the autism parents. As a group they've dedicated themselves to not just supporting their children but to advocacy on all levels--especially, now, with regard to insurance coverage.

The article quotes an autism professional as saying "Most of the major autism organizations, both providers and support groups, have come together in agreement that insurance coverage for all individuals with autism is a positive and important need."

Same goes for anorexia and bulimia, as well we know.

Like anorexia, autism is often not covered, or covered poorly, because it's classified as an emotional disorder rather than a brain disorder. But I say, if your brain isn't considered part of your biological body, then what is it--a disembodied organ floating in space?

One of the autism advocates is quoted as saying "We're continuing to work together in the hope legislators take notice that the need is not going to go away and we're not going to go away."

Hey, what about us? What about those of us who have watched our children waste away or go through hell, only to be told that insurance doesn't cover therapy, or IP treatment or whatever the doctors are recommending at that moment?

What about people like Anna Westin, whose smart, articulate parents fought like hell to get her well, only to be turned down by insurance eventually? Anna committed suicide, and her parents took her experiences to the state insurance commissioner and to the courts and won not just money but also changed the way insurers in Minnesota cover anorexia.

We could do this, state by state. That's what it's going to take, probably, unless we can get the federal mental health parity bill passed.

I'm sick of "steps forward," though, and "making progress." We aren't making progress when it comes eating disorders. What will it take?

Good food, bad food

Sound familiar? I've often wondered where the good food/bad food dichtomy originates. Why is it that carrot sticks carry with them an aura of smug virtue, while chocolate cake bears the stigma of sin?

Of course I know the answer: It's all about the calories, stupid. But there's got to be attitude behind those calories. And there is. Turns out reseachers from Yale and elsewhere did a study several years ago (which I just came across) looking at the stigma associated with obesity. Get this: They quizzed obesity specialists--doctors, researchers, psychologists--and discovered that even people who have devoted their lives to the subject associate "blameworthy behvioral characteristics" with obesity.

These are folks who understand the genetic and environmental factors implicated in obesity. Who know that fat people aren't fat because they watch TV and eat bon-bons all day.

Geez, if you can't trust these people to understand, who can you trust?

This sense of judgment extends beyond food to any part of our lives that our related to fat and overweight. We fatties are told that we bring all kinds of bad things on ourselves, from diabetes to lower pay to heart disease.

If your heart were, I don't know, a sewage pump (which in some ways isn't such a bad comparison), and it got clogged, would you feel a sense of moral failure? Or would you just call the plumber to have the pipes cleaned out? So why the strong sense of self-blame and guilt over being fat?

Stigma equals shame. Shame equals a sense of moral dichotomy, good and bad. People with anorexia take this good/bad food thing to obsessive extremes. But I bet most of us do it on some level.

Pay attention to your feelings about the next plate of food you sit down to. See if it's true for you. Then practice moral blindness when it comes to food. Repeat after me: There is no such thing as bad food, only badly cooked, badly prepared, or bad-tasting food.

Bon appetit.

A Big Fat Bad Idea

I don't watch reality TV. Even if I did, I would not be tempted by this recent offering from TLC. The show reportedly follows a father-and-son team who perform bariatric surgery on "obese people who have opted to undergo weight-loss surgery in an attempt to regain their lives."

And here I thought obese people had lives, even without undergoing the risky-but-oh-so-profitable procedures performed by these butchers--I mean surgeons.

The producers would have you believe that this father and son are dedicated do-gooders out to make the lives of Fat People better by surgical mutilation, we know better.

We know, for instance, that nearly 40 percent of those who underwent such surgery last year had complications within 6 months, including vomiting, diarrhea, difficulty swallowing, reflux, abdominal hernia, leaking at the surgical site between stomach and intestine, and infections of one sort or another.

We know that 7 percent of those who had the surgery had to go back to the hospital within 6 months to treat complications of the surgery.

The producers of this incredibly offensive show describe the father and son as "passionate" people "who have dedicated their professional lives to raising awareness about obesity."

Raising awareness? Um, did we need our awareness raised on this issue? Do those of us whose BMI qualifies us as overweight or obese just not realize it? Is there anyone living in America--heck, in the world--who hasn't been inundated with anti-fat propaganda and prejudice?

Captain Kirk was wrong; fat is the final frontier. And this show is one big fat bad idea.

Gina Kolata rocks

Tomorrow's New York Times Book Review features a review of Gina Kolata's new book, Rethinking Thin. While the reviewer accepts Kolata's most relevant point--that most fat people do not get thin despite countless diets and interventions--she scoffs at Kolata's conclusion: that maybe there's nothing so wrong with being fat.

This is one book I can't wait to get my hands on. The reviewer was obviously biased from the get-go, but luckily that bias is so clear that there's no mistaking it for critical judgment. Kolata is a wonderful science writer who knows her stuff. I'm looking forward to reading it for myself.

Why do women hate their bodies?

Gen-Y journalist Courtney E. Martin posed this question to herself, her friends, and to some of the so-called experts. Then she wrote a book called Perfect Girls, Starving Daughters: The Frightening New Normalcy of Hating Your Body.

The subtitle rocks--I love the juxtaposition of "normal" and "hating your body," which makes you stop and really think about it. Though I don't think there's anything new about the phenomenon. It was "normal" to hate your body when I grew up in the 1960s and 70s. Martin's point seems to be that the pressure to be thin has now morphed into the pressure to be perfect. The opening line of the review that ran in Publishers Weekly reads, "It is no longer enough for girls to be good . . . girls must now be perfect, and that need for perfection is played out in women's bodies."

I'll be curious to read the book and see if it lives up to its title . . . and what, exactly, Martin has to say about eating disorders.

What do you wish your child's school knew about eating disorders?

I'm in the beginning stages of putting together a presentation to give to staff at middle and high schools on eating disorders from the parent's perspective and especially anorexia. My goal is to a) create empathy for students and families dealing with an e.d., b) explain the severity of such e.d.s, c) offer specific practical information on how schools can support families dealing with e.d.s, and d) offer a list of things they shouldn't do, both in general ("anti-obesity" curricula, public weigh-ins, etc) and in specific when dealing with a child in crisis.

So I pose the question to my readers: What would YOU want your child's school to know/do differently when it comes to anorexia and e.d.s? Your input will help me create the most effective and compelling presentation.

And the winners of the Mr. Wrong contest are . . .

I got some really great submissions about romance gone wrong in the Mr. Wrong contest. Who knew there were so many truly awful boyfriends out there? (Well, we all did.)

Two stood out, and I'm going to publish both of them here on my blog. Today's entry is by Cathy Prescott. It caught my eye initially because it takes place in the same part of Wisconsin where I live. Then again, it's just such a good story, I couldn't resist.

So congratulations to Cathy Prescott, my first winner, who will get a signed copy of the book and a T-shirt just as soon as she sends me her shirt size and address. Read her piece for yourself (and weep? laugh?). Tomorrow I'll bring you another installment of MR. WRONG: REAL-LIFE STORIES ABOUT THE MEN WE USED TO LOVE.

By the way, you can still enter (see the link above). The deadline was April 15 but, well, I'm easy about this stuff. And did you know that you, too, can have your very own MR. WRONG T-shirt? It's true. Send me an e-mail and I'll tell you how.


Crash Redpath
By Cathy Prescott

My former husband, James Redpath, was a flying nut. Maybe it stemmed from his days as a Green Beret, or maybe it was because he was a type T personality-fearless.

He bought his first airplane, an EAA Biplane, kit-built, one seater, with money saved to pay our real estate taxes. One seater’s do not allow the luxury of a flying instructor. “I’ll learn by practicing alone”, he said. He crashed it, uninsured, into a shoulder-high corn field near Lone Rock airport while trying to do a loop-the-loop, unable to pull out of a dive. He flattened 20 rows of corn. The emergency room physician called in the local surgeon to stitch-up James’s lacerated nose. After pulling out pieces of green cornstalk from the gaping edges, the surgeon commented that he was trying not to leave any “additional scars”, thus bestowing on James a dubious honor. James was not destined to gain reputation for his face.

His next plane fared better—a J3 Piper-Cub, yellow and black, two seater, with wing struts, and only three dials to read in the open cockpit: altimeter, speed indicator, and oil pressure gauge. The gas level was measured by a floating dipstick on top of the engine. When it quit floating, you were out of gas. He loved the freedom that plane gave him. He could skim the landscape at 1000 feet, come in at tree-top level to say “hi”, and land on his own grassy hillside, in Black Earth Valley. Even Jack McManus (a Madison high profile criminal trial attorney) owned a J3. James knew he flew in good company. Views were spectacular from the passenger-seat, as well. People lining up for a “bird’s eye view” flight were not disappointed. Riders, usually patrons thrilled by flying tales at Club 14, would drive down the hill to the farm, climb in on the strut, and seat-belt themselves in while he spun the prop, to start the engine. A half-hour later, the tinny-drone of the J3’s big radial engine could be heard, and soon the rider would be back on the ground, grinning, impressively awestruck after viewing a 30 mile radius of their own house, including power and phone lines, cows and pasture, and the hills and valleys lining the Wisconsin River.

One sunny June afternoon at three o’clock, James had picked up my 15 year old daughter as a passenger and they departed to do the usual sky-cruising. The sky was perfect, big blue fluffy clouds, visibility unimpaired. After the usual 30 minutes, he decided it was time to start for home as the gas float was dropping. Taking a new route this time, he flew through the neighbor’s North-South valley, which required a left-hand bank to line up for landing on his usual grassy strip below the hillside. This made him forget the whereabouts of the East-West high power-lines running through the valley, a bad mistake.

Into the turn, he clipped that high power line with his prop causing the line to stretch, then break, flinging one broken end into dry grass, starting a grass fire, and draping the other end over the roof of our nearby barn to leave it sparking into space. Remarkably, he was able to land the plane, although the plane had wires wrapped around the prop, and a strut was broken. Miraculously, he and my daughter were uninjured. He picked a most unfortunate time and place to cause this accident, however, as he put out the electricity between Black Earth and Mount Horeb just at milking time, a memorable event to farmers. And the local volunteer fire department had to be summoned to put out the grass fire. As a result, area farmers were most interested to hear who had caused their miserable loss of electricity at that particular time of day, on a beautiful sunny afternoon. They remembered his name.
I’ll bet, if Club 14 were still open, you could walk in there any evening, approach the bar, and ask any farmer sitting morosely, with a mug of draft beer at the bar, if they knew ever heard of a James Redpath? “Oh”, they would say, brightening up, you mean “Crash Redpath. Let me tell you a story about one sunny June afternoon. ”

There is no way to prevent anorexia

As I wrote the title of this post, I felt a wave of despair. Until a couple of days ago, I had never put this thought into words, never articulated it to myself. But it's true.

Two years ago I would have said of course you can prevent anorexia. I certainly never believed my daughter would develop it.

She was smart. She was funny. She was self-aware. She was eminently rational, and had been since toddlerhood. She watched no commercial TV. Her videos were carefully screened. She was a feminist before she started kindergarten.

Every kid in her sixth-grade class had to do a research paper on a subject of interest. She did hers on eating disorders. Looking back, I understand that that right there was a clue. At the time, I thought it made her safer because she had knowledge, she understood, and she was warned.

I thought that years of modeling a healthy attitude toward my own body would protect her. (I was fooling myself there, too, but I tried hard.)

But here's the thing: Nothing that she did or I did protected her from anorexia. Because there is no way to prevent an eating disorder.

If anorexia could be prevented, we wouldn't need to be talking about treatment. We wouldn't need to watch children suffer or families unravel.

I know from my own daughter's experience that knowledge does not prevent anorexia. She knew more about anorexia in sixth grade than many doctors do. She understood the dangers. More, she knew she was--as a gymnast and perfectionist--at risk. But it didn't help.

I'm all for the studies now being done on treatments for anorexia. They're long overdue. But where are the studies on prevention? Why is no one even asking the question of how to prevent anorexia and bulimia? Cynthia Bulik has looked at anorexia and twins--this would seem to be a perfect area of research for her.

We know that genetic predisposition plays a huge role in eating disorders. We know that environment can be a catalyst. How does the famous saying go? Genes load the gun and environment pulls the trigger. What we don't know is how to put the safety back on the gun. We'll never know until we start the scientific process of figuring it out: coming up with hypotheses, testing them, recording the results, making connections.

I've watched half a dozen young women I know--all of them bright, funny, well-read, engaging--fall prey to anorexia. I can look around at the young teenagers I know and predict, now, who's at risk. It's like watching a train wreck in slow motion.

Treatment is crucial. God knows we need better treatments for anorexia. Maudsley treatment is the best we've got so far, and it saved my daughter's life. I'm grateful. But it's not enough. Enough is when we can keep kids from becoming anorexic in the first place.

I don't have the answers. Maybe it's a combination of things: a vaccine, education, behavior modification in those at risk. I don't know. But I do know that until we start asking the question, we'll never find an answer.

Clinton's crusade

Bill Clinton's new crusade against obesity is making headlines and blogs around the world. The media just can't resist the image of a formerly fat former president calling for more ammo in the war against obesity.

If only Clinton would harness his power for good--imagine what he could accomplish!

Don't get me wrong--I'm an FOB (fan of Bill's) from way back. But I sure wish he'd take a stand for something truly meaningful, like national health insurance or truly meaningful mental health parity. Or how about pushing for an hour-long school lunch, like the French have? Or daily recess for all schoolkids?

And hey, Bill, as you wield your influence for the good of children everywhere, I hope you will take the time to educate yourself about eating disorders. I hope your efforts stay focused on supporting children's health in all ways rather than fat-bashing--which we all know is ineffective at best and cruelly destructive at worst. I would hate to see more of what helped trigger my daughter into food restricting and, ultimately, anorexia: mindless labeling of "good" foods and "bad" foods, fear-mongering at the table, and more prejudice against those who don't conform to cultural ideals.

The Missing Link

In the lexicon of sensationalized news stories, there are none quite as poignant as stories like this headline from the Times of London: "15st boy is taken from grandparents who lost their daughter to anorexia."

The story goes on to describe, in horrified tones, how a 10-year-old Spanish boy was removed from his grandparents' custody after they overfed him until he reached 200 pounds. The story goes on, predictably, to quote experts familiar with the case as well as those who were not about the dangers of obesity, how obesity is on the rise, etc. etc.

Buried up near the front of the piece is a crucial nugget of information, mentioned once and never referred to again. The grandparents had custody in the first place because the boy's mother had died of anorexia.

It's tragic that no one quoted in this story (and for all I know, in the boy's life) has made the connection between his mother's death from anorexia, his grandparents' feeding behavior, and his own eating. Imagine watching your daughter or your mother starve herself to death. Imagine the grief, the guilt, the disbelief and lack of understanding. Of course that has an effect on everyone's relationship to food.

Authorities took the boy away from his grandparents and put him on a diet. They report that he has now lost more than 20kg and that they'd like to return him to his grandparents' custody. The story goes on: "But they say the grandparent remain “in denial” that their feeding habits are a problem – health officials said that they even tried to smuggle chocolate biscuits to him during their weekly visits. “The problem is that the grandparents still don’t understand that they were harming the lad and seriously placing his life and future at risk,” Ms Fernández said."

What will it take for us to look at the relationship with food and eating as a whole package and not isolated bits of pathology? My heart goes out to this boy and his grandparents.

Listen to Mr. Wrong

Yesterday I was interviewed by Deborah Harper of Psychjourney about MR. WRONG: REAL-LIFE STORIES ABOUT THE MEN WE USED TO LOVE. She was one of the most thoughtful interviewers I've come across, and I'm pleased with how it turned out.

So just in case you're interested, I'm going to try to post the link to the interview here. You can always email me and I'll send you the MP3 file if this doesn't work.

To Diet or Not to Diet?

Just in case you were wondering, the answer is pretty clear: Diets don't work. But then we all know this already, don't we?

Part of my daughter's recovery from anorexia has been to reconnect with her own feelings of hunger and fullness. For a long while she never felt hungry--or at least, she never felt a physical sensation she could identify as hunger. I think she was very hungry underneath the anorexic mind that temporarily took over hers. The most emotional moment of her recovery was the day she called me at work to say, "Mom, I'm hungry!"

I've never been anorexic. But I, too, had to learn to feel hunger again after years of training myself not to. I had to experience the scary feeling of being hungry and reassure myself that I would eat, that I would feed myself--and that I would stop eating when I wasn't hungry anymore.

I grew up dieting and binging. That's what we Jersey girls did in the 1960s and 70s, especially if our mothers lectured here. And while I never unearthed a treasure like this one, I did effectively divorce myself from every feeling having to do with food.

Too bad I couldn't divorce myself from the self-loathing that dieting--and falling off the diet--regularly imposed.

Whichever end of the spectrum you approach it from, dieting looks pretty lame. It's a multi-billion-dollar industry, and that's why it still has street cred, despite the crummy statistics around its efficacy--only 2% of dieters keep their weight off, according to the UCLA researchers.

I feel the same about dieting as I do about using illegal drugs: I sure wish I hadn't done that when I was young and naive and ill-informed.

So those of you who might be on the fence about it: Just say no.

Of pregnancy and fat phobia

Another post from Sandy Szwarc highlights the peculiar and dare I say twisted mentality that comes from living in a culture that's fat phobic in the extreme. Szwarc's talking about the latest media anti-fat media blitz, this one focused on the relationship between weight gained in pregnancy and overweight toddlers. Specifically, according to the study's authors, women who gain even the accepted amount of weight during pregnancy run four times the risk of having a child who's overweight at age 3.

Scary, huh? Apparently much scarier than another finding buried in the study, which received neither headlines nor any media attention: the fact that women who didn't gain enough weight during pregnancy had double the risk of having a baby with intrauterine growth retardation. According to Szwarc, Babies with IUGR are at vastly higher risks of stillbirth and serious medical problems during infancy if they do survive.

This reminds me of the recent study published in the New England Journal of Medicine, which found that being underweight or of "normal" weight (and let's not even go there for now) correlated with higher rates of mortality than being overweight. (Thanks to Paul Campos for writing about this!) This unpopular finding has been scrutinized and rationalized to death, because apparently it's unbelievable that having nutritional reserves (i.e., being fat) could possibly confer any health benefits.

This, in turn, reminds me of the way doctors and therapists who treat eating disorders sometimes fall inadvertently into the language and perspective of those eating disorders. How people with anorexia can walk around at weights that are dangerous, yet no one notices because we've been so conditioned to think that thin = healthy and good.

Apparently we live in a culture where death is preferable to being fat. Even for babies. Even for toddlers.

Some years ago I dealt with this in my own life, after a severe depression sent me into a tailspin (what would have no doubt been called a nervous breakdown 60 years ago). Antidepressants lifted the fog and gave me my life back. They also, over a period of 5 years, led to a 50-pound weight gain. To me it was no contest: I'd rather be sane and happy and fat than thinner and miserable.

I wonder how many people would agree with me?

The Big O

A quick post this morning because I couldn't resist linking to the blog of Sandy Szwarc, whose smart, thought-provoking blog I love. Recently she wrote about the so-called obesity "epidemic" in a way that had me cheering from the sidelines.

This follows on the heels of my pulling my sixth-grader out of her required "wellness" class, at least for the nutrition and "obesity" parts of the class. Because isn't it a great idea to take a bunch of impressionable 6th-graders and brainwash them into thinking that the only healthy food out there is a carrot stick or salad (hold the dressing!)? Given the fact that most eating disorders start between 11 and 17, this seems like a bad idea to me, especially the way such things are taught. But don't take my word for it--read Sandy Szwarc's blog. Great stuff.

Mental health parity

Here in Wisconsin, we don't have mental health parity, a fact I often moan about. If only we had it, I often thought during my daughter's recovery, we would be able to get the treatment we need for anorexia, bulimia, and other eating disorders.

Parents in New Jersey, where there is mental health parity, found that insurers still discriminated against e.d. treatment, denying and disqualifying it in the face of medical advice. Dawn Beye is one parent who got sick and tired of waiting for her insurer to do the right thing and cover her daughter's treatment; she and other parents filed a class action lawsuit to have anorexia classified as a "biologically based illness." Apparently insurers in New Jersey differentiate between biologically based mental illnesses (depression, etc) and non-biologically based mental illnesses.

I guess they think anorexia is all in our heads. They ought to read NAMI's stance on this, not to mention the opinions of many other clinicians and professionals. But then we all know that health insurers know more than doctors when it comes treatment protocols and appropriateness. Right?

When I rule the world, we'll have national health insurance (which goes without saying). And that national health will cover evidence-based treatment for eating disorders, plus support families using the Maudsley method and other approaches yet to be discovered for helping their children recover from e.d.s.

Beye's daughter is still in-patient after 10 months. Beye and her husband still don't know how they're going to pay for her treatment. They could wind up owing several hundred thousand dollars if Aetna doesn't do the right thing and cover the IP treatment.

As my grandmother would have said, it's a shanda. And if you don't know what that means, look it up in Leo Rosten.

Anorexia and control

How many times have you read it or heard it: Anorexia is all about control. And its corollaries: People with anorexia have to choose to eat. Parents who try to make them eat have control issues.

Those of us who have used the Maudsley approach to help our children heal from eating disorders don't buy this. But the rest of the world still does.

I know a family that's had both kinds of treatment for their anorexic child. The mom put her finger on how each felt to her: "Anything less than Maudsley gets into really icky murky games. Maudsley is brutally hard but man it is all above board: parents want kids to eat. Period. What we've been doing instead is no less psychologically tense or painful."

That's exactly what I appreciate about the Maudsley approach: It's all right there out in the open. No hidden agendas, no submerged power struggles. Parents want their child to eat. They require it. They support it. Not out of a need to control, or boundary-crossing, or a wish to keep their child small, or any of the other accusations leveled at parents of anorexics.

We require our children to eat because we love them and want them to get better.

What could be wrong with that?

Eating disorders and self-esteem

The question I've been chewing on lately is this: What's the connection between eating disorders and self-esteem?

Does low self-esteem lead to, contribute to, or cause eating disorders? Conversely, does boosting self-esteem make one less susceptible to e.d.s?

I started thinking about this after following a link to an interview on Studio 2B, which bills itself as "a site for teens." The interview is with Scarlett Pomers, a 17-year-old actress who was treated for anorexia in 2005 and is now involved with the National Eating Disorders Association. In it, Pomers reinforces the link between positive body image, self-esteem, and health. She quotes some scary statistics--half of all girls between ages 12 and 14 say they're unhappy because they're too fat--and offers earnest suggestions for teens who may know someone with an e.d. or who may themselves be struggling with one.

All to the good. I do believe the more we talk about eating disorders, the less stigma is attached to them. But I'm not sure about the connection with self-esteem.

Before anorexia (and now again, as she's in recovery) I would have described my daughter as confident, smart, funny, outgoing, and emotionally astute. Her descent into anorexia did not seem connected with low self-esteem. On the contrary, she seemed to develop low self-esteem--along with a slew of other problems--only after becoming anorexic.

I don't want to knock efforts like NEDA's and others to try to boost girls' self-esteem. It's not a bad thing in this post-Reviving Ophelia culture. I'm wondering, though, if efforts like this are enough, or speak to the right point.

At the very least, shouldn't they be paired with education around nutrition--not the deluge of anti-obesity propaganda that now passes for "wellness education" but a clear, matter of fact explanation of what teens need to eat in order to be healthy? It wouldn't hurt to have a unit on, say, how and why diets don't work, too.

I don't know that this will prevent anorexia and bulimia in those who are susceptible. Maybe it would be a good start, though.

I would really like to hear what other people think on this subject.

Book review: Take Charge of Your Child's Eating Disorder

I really wanted to like Take Charge of Your Child’s Eating Disorder, co-written by Pamela Carlton, M.D., who directs Stanford University’s Adolescent Eating Disorder Parent Education and Support Program. I’m a huge fan of the work being done at Stanford by James Lock and nearby at UC San Diego by Walt Kaye. But after reading this, I want to ask them both, “How could you have let this happen?”

Families with anorexic or bulimic children need all the information and help they can get. But for the most part, they’re not going to get it here.

If I’d read Carlton’s book when my daughter was newly diagnosed with anorexia, I would have wanted to shoot myself, mostly because of statements like this: “Full recovery from anorexia is not easy, and many people struggle with ongoing body image disturbances and disordered eating behaviors throughout their lives. Fortunately, with early treatment, your child’s chance for full recovery is likely to be increased.” (p. 9) This leads parents to believe that their child will be dealing with an eating disorder for the rest of her life—which in many cases is simply not true.

In reality, there’s lots of hope for full recovery, especially among adolescents who are treated early with family-based treatment, also known as Maudsley treatment. Nowhere does Carlton mention this as one of the treatment modalities for eating disorders. Instead, she recommends that parents put together a treatment team—a good idea, in and of itself—and says, “The most important thing to remember is you cannot do this alone.”

Actually, you can do this alone, and sometimes you should. A treatment team is great, so long as everyone is on the same page. My husband and I assembled a terrific treatment team, but there were times, inevitably, when they contradicted one another or said just the wrong thing to our daughter. It’s certainly better to have no therapist than a bad one—and the vast majority of eating disorders specialists out there are bad, make no mistake about it. A third of them have or had eating disorders themselves, which tells you something right there.

Throughout the book, Carlton pays lip service to the idea that parents should be involved in their child’s treatment. But she doesn’t actually seem to believe it. Take this example she offers about a 15-year-old, Jinny, in treatment for anorexia. She writes that because Jinny was fixated on her weight, she did not give the girl her weekly weight updates. Fair enough. Then she writes, “But after each appointment, her mother would follow me out of the room with her notebook, ready to write down a weight, promising, ‘It’s okay, I won’t tell Jinny.’ I finally told her this was not healthy for Jinny and her actions were undermining my efforts to help her stop focusing on her weight. We came up with a solution: since she really needed to know her weight progress, I would meet with her once a month to review her progress. Yes, I would share her weight with her, but she had to accept that it would only happen once a month and not at her daughter’s appointment.” (pp. 84-85)

Of course any parent who has watched their child starve themselves nearly to death is going to be fixated on weight. Each pound gained represents another step away from the awful abyss their child has fallen into. The notion that such interest is unhealthy or somehow undermining treatment is both wrong-headed and deeply offensive. I hope this mom fired Carlton and found a smarter, more compassionate therapist who would actually empower the family to help Jinny recover.

Carlton insists that families need to find experienced eating disorders therapists and specialists to make up the treatment team for their child. In my family's experience, the “specialists” were frequently so heavily invested in their own particular take on eating disorders—-and often this was an outmoded and ineffective one—-that they were not able to give my daughter what she needed. A good therapist can be helpful. A bad therapist can do a lot of damage. And you don’t need collateral damage when you’re dealing with an eating disorder.

Finally, Carlton seems to subscribe to the notion that eating disorders are caused at least in part by psychology: “Without appropriate psychiatric help and treatment, eating disorders can become lifelong illnesses. To regain a healthy relationship with her body and with food, your daughter may require long-term treatment, which may continue long after her body is considered medically healed. The average length of psychological treatment is two to three years.” (p. 88)

Actually studies on family-based treatment (the Maudsley approach) show that teens often recover without this kind of intensive psychological or psychiatric treatment, and the recovery "takes": 90 percent are still recovered five years later. Carlton’s perspective gives families the wrong message: that only the doctor can “take charge” of their child’s eating disorder and bring about recovery.

In my experience, and in the experiences of many families I know, the reverse is true: recovery happened when parents were empowered to "take charge" of their child's recovery, often with backing from a truly supportive team.

The best part of this book is the insurance section. Too bad Carlton didn't publish just that. Except for that one chapter, you’re better off reading Help Your Teenager Beat an Eating Disorder by James Lock and Daniel Le Grange or Eating With Your Anorexic by Laura Collins.

Is anorexia like alcoholism?

The first question people ask after they read our family's story of helping our daughter Kitty recovery from anorexia: Is this like alcoholism, where she'll be dealing with it for the rest of her life?

It's a fair question, given the fact that traditional rates of relapse in anorexia are extraordinarily high--up to 50% of anorexia sufferers relapse within a year of treatment, according to one 2001 study. I know of several girls my daughter's age who are in the midst of relapses right now. My heart goes out to them.

The first few times people asked this question, it made me cry. The thought that my daughter might have to deal with anorexic thoughts, feelings, and behaviors for the rest of her life is awful and scary and beyond demoralizing.

But there's good reason to hope that for girls like Kitty, whose anorexia is treated relatively quickly (within 3 years of onset) and who become fully weight restored (not to 90 percent of their ideal body weight, as many clinicians are willing to settle for, but to 100 or 110 percent), relapse is far less likely. Preliminary studies of long-term outcomes for teens treated with the Maudsley approach, or family-based therapy, are very promising.

So now when people ask the question, I answer this way: We don't know what will happen for Kitty in the future. But we're hopeful that 10 years from now she will look back on anorexia as one of the trials of adolescence, not as a defining moment in her life. She'll remember it (actually I hope she doesn't remember many of the really bad moments) rather than still be experiencing it.

Our job will be to watch and protect her for the rest of her adolescence, especially when she goes to college, which is often a vulnerable time. Which, when you think of it, is what a parent's job is all about, anyway--to protect and take care of a child.

The rest of the family

An incident that happened at my sixth-grader's school last fall prompted me to write a piece about the effects of eating disorders on the rest of the family, which appeared in yesterday's New York Times. (Sorry, I can't do links when I'm blogging remotely, and right now I'm sitting at the airport waiting for a flight that's been delayed 6 hours.) The URL is http://www.nytimes.com/2007/03/06/health/06case.html?em&ex=1173416400&en=774d3d641fa1234b&ei=5087%0A.

But truly, this kind of fallout is true whenever one child in a family is desperately ill, particularly if the illness has a chronic or potentially lethal component. Having a sibling with cancer, diabetes, autism, developmental delays, and other conditions always creates a difficult situation for the other sibling.

I was an other sibling when I was growing up. Today, no doubt, our family would have wound up in family therapy, but back then my sister was the one who got the diagnosis "emotionally troubled," whatever that was supposed to mean. I now understand that she was most visibly acting out many of the feelings swirling around our little family. Even so, her behaviors and condition dominated the household.

I remember what it was like to have to stuff my feelings so as not to upset the teetering balance of our family dynamic; to resent the attention she got even though it was mostly negative attention, and clearly she was miserable; to wish that her problems, whatever they were, would just go away. This perspective was much on my mind last year and now as I watch my younger daughter struggle with the fallout from her sister's illness.

I have enormous respect for both my daughters, for the pain and difficulties they have both suffered, as well as for all children living with chronic illnesses, whatever they are. And I'm grateful that we now understand a lot more about how illnesses like these change the family, and what to do about it: Get the best medical care possible and then love the heck out of our children, and ourselves.

Maybe that's not so different from what our parents did.

Another Lead Fork award goes to . . .

the well-meaning but clueless youth director who recently sent home a flyer to parents in her church describing an upcoming activity for middle-schoolers titled "Hunger Feast!" This activity, which was described as "strongly encouraged," involves middle schoolers going without food for 30 hours in a lock-in at the church to "raise our awareness of hunger in the world and in our midst." The flyer goes on:

"Many of the activities we do during the lock-in focus on food (preparing food for and sharing it with others, doing volunteer tasks in the pantry, etc.); so we feel the ache of knowing that food is available to some, but—for this brief period of time—not to us. Experiences like this deepen our understanding of and increase empathy for the real human suffering that underlies the statistics.

There is, however, another aspect to this time of fasting. Fasting is a spiritual discipline, defined as “the voluntary abstention from an otherwise normal function—most often eating—for the sake of intense spiritual activity”. In addition to our hunger awareness activities, we also experience worship and prayer. It is always touching to observe the tender reactions of youth when they experience worship after having gone without food for a whole day. It is a powerful experience."

My recommendation: If you want your middle schoolers to develop empathy for those who are hungry, educate them--and yourself--about eating disorders. Celebrate food as part of life--a holy part of life, if you will--and have your kids volunteer at a food bank or soup kitchen. But for god's sake--and theirs--don't make self-starving holy or exalted.

National Eating Disorders Awareness Week

Today marks the start of National Eating Disorders Awareness Week, and our family marked the day by taking part in the Virtual Family Dinner sponsored by Maudsley Parents. We sat down to dinner at a friend's house and ate chicken curry, salad, and homemade pumpkin chocolate chip muffins.

The food was delicious. Even more delicious was the fact that we all ate, together, and ED was not at our table. Not tonight, anyway, and hardly at all for the last nine months.

Two years ago we were still ignorant about our daughter's anorexia. A year ago we were in the midst of Maudsley treatment. Tonight we ate with the memories of anorexia fresh but beginning to fade, and the hope that next year we will be that much further away from the nightmare.

My deepest wish for all of you, all of us, is that in the years to come we banish ED from all of our dinner tables. That we learn to feed ourselves and one another with joy and love and appreciation for what tastes good as well as for our selves, body and soul and mind and heart.

Jane Brody on binge eating disorder

Jane Brody wrote a personal and very powerful column in yesterday's New York Times about her own experience with binge eating disorder. It's worth reading, whether you've had experience with BED or another eating disorder or not, for its description of the slow, inexorable descent into hell that eating disorders entail.

Defintely worth a read.

Anorexia as metaphor

Recently I've read seveal memoirs about being anorexic, or books by doctors about eating disorders, that emphasize the metaphoric context of anorexia and bulimia. They talk about anorexics craving emptiness and hunger, the politics of appetite, the power trip of self-starvation.

I can see that for those who suffer from anorexia for a long time--more than a year? more than two?--the natural human tendency to assign meaning and metaphor to biological reality kicks in. When you live with something for a long time, it becomes part of your self-image, a key element in how you see yourself.

Such writers tend to make an important and to my mind unsupported leap, though. They generalize backward from their own situation, years down the line with anorexia, and conclude that the metaphor is what causes girls and boys to become anorexicv. This is the classic pitfall in anorexia treatment, the conventional wisdom espoused by doctors and therapists. And it's wrong.

It's important for parents and therapists and doctors to not get sucked in to the persuasive world of the anorexia metaphor. To remember that the vast majority of anorecxics become sick accidentally, from a diet that takes on a life of its own, an illness, a natural propensity for losing weight that gets pushed too far in some way and takes over a child's physial and psychological life.

To buy in to the notion of anorexia as metaphor is, frankly, to fall under its sway. I think this is one reason why, as Daniel Le Grange told me, even doctors and therapists sometimes make bad decisions about anorexia. "It's as if the anorexia affects the thinking processes of those around the sufferer," he told me.

I think the mechanism he was talking about is metaphor. And that's why I think it's absolutely vital that we de-metaphorize anorexia. We can best help our children--and other people's children--by taking anorexia's power away, both literally and metaphorically. By remembering that anorexia is a biological disease and that its symptoms and consequences are larely the result of starvation. And that the first line of treatment for it is not psychological but physiological: food.

There is time later, after a child is weight restored and mentally restored, to discuss the metaphors of eating disorders, if they apply. But it's a dangerous trap to fall into that conversation right away.

Why do we settle for treatment that doesn't work?

This morning I'm feeling so grateful for the Maudsley approach of treating anorexia, which I am sure saved my daughter's life. While there may be a better treatment out there yet to be discovered someday, for now Maudsley is so much better for teens than traditional treatment that it's hard for me to understand how and why professionals could recommend anything else.

Especially pediatricians. They're the ones on the front lines. They're the ones who presumably know a child, watch his or her growth from infancy on. Who have a chance to see the growth curve and know when a child is "just thin" or "too thin." When thinness becomes pathological.

Often pediatricians wait far too long to flag a problem--very likely because they're watching for the opposite problem, overweight in teens. Our society has such a strong fat phobia that all of us, myself included, have to struggle to take off our "thin-is-always-good" glasses and see reality sometimes.

Some pediatricians will notice a drop in weight or off the child's growth curve, but then stall when it comes to treatment, letting months or even years go by while a child starves and anorexia becomes more entrenched. Why? Could it be that many pediatricians--especially women--have eating or body or weight issues themselves?

If your intuition tells you that your child might have a problem, get another opinion. Follow your gut. The treatment you pursue might save your child's life. And you don't have to settle for treatment that doesn't work. There is hope for anorexia. The vast majority of teens treated with the Maudsley approach are weight restored, fully recovered, and back to normal life--and stay that way five years down the line.

Don't settle for anything less than your child's best life.

If you've ever loved a Mr. Wrong . . .

I'm looking for a few brave readers to read MR. WRONG: REAL-LIFE STORIES ABOUT THE MEN WE USED TO LOVE and write a review for amazon.com. I'm going to NY this week (tomorrow, actually) to promote the book and a couple of reviews on amazon would help. And of course, I hope you like it and write a good review, but hey, you should tell the truth.

If you're up for a little book reviewing, click here.

Happy reading!

Ranking eating disorders

Last week a study published in the journal Biological Psychiatry (love the name! um, what other kind of psychiatry is there?) made the headlines by proclaiming that the most prevalent eating disorder in the U.S. is binge eating disorder. It said that 3.5% of women have episodes of "uncontrollable eating" at least twice a week for at least three months at a time. In classic sensationalist style, BED is now bring described as the "biggest" eating disorder in the U.S.

I had binge eating disorder for much of my teens, 20s, and 30s. It didn't have a name then, or at least I was unaware of it. It didn't seem unusual to me; other women in my familiy clearly had it too. It wasn't a good thing, and I wanted to change my eating patterns. I saw various therapists and finally landed with a good one in my late 30s. I signed up for 10 weeks of eating sessions and wound up with 8 years of intensive, fantastic therapy. Somewhere along the way I stopped eating compulsively, and while I still overeat on occasion, I have a healthier relationship with food now.

I hardly noticed when I "recovered" from compulsive eating. My weight dropped a whopping pounds. That's about it.

Why am I telling you all this? Because I'm worried that the hoo-ha over binge eating disorder will add fat (excuse the pun) to the anti-obesity fire. And that's bad news for all of us, whether we're fat, "normal," or suffer from anorexia or bulimia.

I don't want to play the "which is worse?" game. But as someone with personal experience of both B.E.D. and anorexia, I have to say there's no comparison. B.E.D. isn't a good thing, but it doesn't disrupt your life. Anorexia, the most deadly psychiatric disorder, kills. And while some people maintain a facsimile of ordinary life while they're anorexic, most do not.

I'm not saying it's OK to have an eating disorder. But I worry when I see all e.d.s lumped into the same category and discussed in the same terms. It simply isn't true. Anorexia is a life-and-death diagnosis. B.E.D. is not.

More anti-obesity rhetoric won't cause the prevalence of anorexia to rise, but it might trigger more people who are susceptible into active restricting and anorexia. And it certainly contributes to the culture of thinness that reflects our overall disordered relationship with food and eating.

It can and does affect treatment protocols, too. In my experiences (and the experiences of many families I've talked to), I've seen how the culture and bias toward thinness extends into the medical profession--sometimes quite deeply. One of the dirty little secrets well known among families with anorexic children is that doctors consistently set target weights that are far too low for true recovery. Not surprising, when you consider that a third of all eating disorders specialists have suffered (or still suffer) from an eating disorder themselves.

So my fear is that all this uproar over B.E.D., and how it's the "biggest" e.d., will cause more grief for families who are struggling with the ravages of anorexia.

New York City, here we come!

I'm always excited to be heading back to New York City. I lived there for 14 years, most recently here. Next Tuesday my friend Gale and I will be heading east for 4 days in the city I love most of all.

Tuesday night I go right from the airport to a midtown radio studio, where I'm a guest on the "Busted Halo Show" with Father Dave Dwyer. That should be interesting! Then it's uptown to 190th Street to stay with dear old friend (and ex-Mr. Wrong) and his really great wife. (It really is true--one woman's Mr. Wrong is another woman's dream come true!)

Wednesday night is The New York Reading. Come on out and have a good time! I'm bringing some of these with me, unless airplane security takes them away before we board. Some of my favorite writers are reading, too--Roxana Robinson, Catherine Texier, Dana Kinstler, Raphael Kadushin, and me. 7 o'clock, Barnes & Noble, 82nd & Broadway. I'm bringing my Mr. Wrong T-shirts, too--maybe you'll win one at the reading.

Oh, and along the way I plan to eat a lot of Japanese food. Yum. At my favorite restaurant, Natori, if it's still around.

Valentine's string cheese?

In today's Wisconsin State Journal, columnist Susan Lampert Smith wrote about how parents at one school in southern Wisconsin have been asked not to send in the traditional Valentine's treats--cookies, cakes, and especially those little conversation hearts. Only slightly tongue in cheek, Smith suggests that parents send in string cheese for Valentine's Day treats, and writes, "This, sadly, is what Valentine's Day has become in schools where the federal wellness policy is being interpreted with revolutionary zeal."

You go, Susan. The zealots at this and other school districts obviously haven't read the studies on the effects of deprivation on eating habits. Restrained eating--in this case, telling kids they mustn't eat sweets for Valentine's Day--usually winds up making them eat more sweets, later on. If you've ever been on a diet, you're familiar with this paradigm. We're hard-wired to eat, and deprivation only triggers that urge, often leading to binging--often on the very thing you'd been deprived (or deprived yourself) of.

I saw this in my own children when they were young. Anxious to save them from the conflicted relationship I had with food, I enforced a stringent low- or no-sweets policy at home. The result? They became dessert hounds on playdates at other kids' houses.

A more sensible approach--and one I've applied to my own eating--would center around moderation rather than deprivation or binging, with plenty of opportunities for physical activity.

Of course, anyone who expects the school system to be sensible about anything is in for disappointment. But I hate the thought of all those federal dollars going toward food policies that actually cause some of the problems they're designed to help solve. I'll be sending a treat in my younger daughter's lunch bag on Valentine's Day. And I'll be glad to explain why to anyone who asks.

Girlpower--or why I wish I lived in Sweden

A while back someone e-mailed me about a health campaign out of Sweden called Girlpower. Tonight I was looking for the link, and came across a program by the same name, but out of the U.S. Department of Health and Human Services.

Eventually I found the one I was looking for. It's worth looking at, especially if you've ever had any body image issues (which unfortunately covers the vast majority of westernized women).

Not that I think stuff like this causes eating disorders. But it sure can trigger them among kids who are susceptible. And I know for myself that if you look at enough of this kind of image, the face and body you see in the mirror are always going to look inferior.

That's why I'd rather live in Sweden. It's no perfect society, but at least they're doing something right.

Post-traumatic anorexia stress syndrome

I haven't posted in a few days, mostly because I'm feeling sad.

Sad about my daughter Kitty's illness, even though she is doing quite well now. Because she is doing well now, probably.

Last year at this time it wasn't safe to feel sad, or mad, or anxious. It really wasn't safe to feel much of anything. Last year at this time her father and I were relentless cheerleaders in the land of anorexia recovery.

This year, we are back to what passes in our house for normal life. Kitty is off to the state Latin convention tomorrow, where she will stay in a hotel with lots of other teenagers (and teachers), play Latin games, and generally have a swell time. Last night she came in 6th in a XC ski race. Go, Kitty!

You've heard of the 5 stages of grief--how about the 5 stages of anorexia: 1. Formless worry. 2. Emergency/crisis. 3. Battle with the demon. 4. Jubilation at recovery. 5. Post-traumatic anxiety.

I think I'll call this Post-Traumatic Anorexia Stress Syndrome. PTASS. It's a good thing, basically, because it means things are good.

I wonder how we'll all feel a year from now?

Gisele Bundchen, educate yourself!

Supermodel Gisele Bundchen thinks she knows what causes anorexia: weak families.

Because she's not anorexic, and she comes from a strong family, she's deduced that anorexics must come from weak families.

This is what's known in philosophy as a tautology. Or something like that. It's faulty reasoning, circular logic, and a bunch of hooey.

It's also unfortunate that someone with as much power to draw media attention is saying things like this, because many families and professionals will listen to her uninformed words.

Gisele, I'm glad you're able to be a supermodel without falling prey to the awful disease of anorexia. But frankly, you don't know what you're talking about here.

Take a look at some of the very latest research on anorexia and genetics. Then how about coming out with a more useful pronouncement on the topic?

I dare you.

Have dinner with your family on Feb. 25!

Just in case you needed a reason to make family dinners more of a priority, here are some fascinating statistics:

* Kids whose families eat dinner together more often eat better and show less eating-disordered behavior than kids whose families eat together less often

* Kids whose families eat dinner together three times a week or less are twice as likely to try marijuana and cigarettes and 1-1/2 times likelier to try alcohol than those whose families eat together 5-7 times a week

* A 2001 University of Michigan study found that family meals trumped most other predictive factors in kids’ lives, including amount of time spent in school, studying, church, playing sports, and in art activities. When the results were statistically controlled for gender, race, family structure and employment, income, social class, parents’ education and age, and family size, family meals were still the single strongest predictor of better achievement scores and fewer behavioral problems
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And what better way to honor National Eating Disorders Week this February than to schedule a family dinner?

To celebrate the role of family support in recovery from eating disorders, the Maudsley Parents group (of which I am proud to be a founding member) will sponsor a worldwide Family Dinner on February 25. Sign up to share a meal with your family that day, and you'll receive a Gold Fork pin and NEDAW materials on request.

My family's in--how about yours?

Support group forming

I'm thinking of starting a weekly support group for parents using the Maudsley approach to refeed their anorexic children. I've had a couple of parents say they would love such a group. If you're interested (I'm in Madison, Wisconsin), send an e-mail to hnbrown@tds.net.

Anorxia, culture, and a Golden Fork award

JG's thoughtful responses to my previous post included a link to an interesting article on eating disorders and culture. It's a good overview of the conventional wisdom on the role of culture in eating disorders, and I'm putting the link up here in case anyone wants to read it.

JG writes, "I'd give anything to spare a young woman today from going through what I did." That's how I feel--I'd give anything to spare a young woman from going through what my daughter did.

I think if we keep talking about this, keep questioning, raising the issues, that's a good thing. I wrote here months ago about the posters at my younger daughter's middle school--there were bulletin boards in the hallways promoting "healthy eating," exercise, and, yes, unbelievably, weight loss. I went in and talked with the assistant principal about it. The posters went away for a while, and have no, my daughter says, been replaced with posters saying something like "Losing weight is not healthy for children and adolescents."

Yay! Hamilton Middle School got it! I hereby award them a Golden Fork award for being responsive to the issue. One small step at the table, one giant step (I hope) for our understanding and treatment of eating disorders.

Fear of food

I was in the food co-op this afternoon, picking up a bunch of spinach, when another shopper spoke to me. She was a young mother, shopping with her preschooler, and she watched me put the spinach in my cart with frank shock. Then she shook her head. "Boy, you're brave," she said.

It took me a minute to understand what she was referring to. Once I got it, I couldn't stop thinking about it. Here was fear of food in a different context from the one I'm used to seeing--the kind of fear of food anorexics feel--and it made me think. Our relationship to food is so primal, so necessary for survival, that to be afraid of it seems not just counterintuitive but, also, awful.

If I'm honest, I must admit that I have fears around food, too. I'm guessing many of us do. I spent years being afraid of fat because of the cultural hysteria around overweight. I grew up in the 1960s, eating a lot of packaged, chemically preserved food--Snowballs and Tastykakes, anyone?--and now try to eat organic when I can, partly from fear of what's in our food supply, partly because organic food tastes better, and partly because organic practices are better for the earth and animals.

And I got to wondering just how pathological my food fears are. I'm not afraid of spinach--in fact I cooked it up and ate it for dinner, and it was delicious--but I wouldn't willingly eat a hot dog (red meat, nitrates).

How sad to have fear enter into the essentially joyful relationship we should have with food. I don't make New Year's resolutions, but I think I'll make that a priority on my list this year: to vanquish my own food fears and reestablish a healthier and happier relationship with food in 2007.

Mr. Wrong goes to New York!

The publication date for MR. WRONG: REAL-LIFE STORIES ABOUT THE MEN WE USED TO LOVE is getting close, and I'm thrilled to be traveling to New York City for a reading. Even better, I won't be standing up there alone, but will be in the company of some of the highly entertaining writers with essays in the collection--Roxana Robinson, Catherine Texier, Caroline Leavitt, Raphael Kadushin, and Dana Kinstler. The reading is at the Barnes & Noble at 82nd & Broadway, Feb. 7 at 7 p.m. It's going to be a lot of fun.

For those of you closer to (my) home, I'll be reading on Feb. 14 at Borders West in Madison, along with Jackie Mitchard and Raphael Kadushin.

Watch this space for news of the MR. WRONG contest--and to find out how you can win a chance to tell your story to the world, plus a signed copy of the book and a MR. WRONG T-shirt. Yes, I'm having T-shirts made up, and they're a hoot.

Anorexia treatment and mixed messages

Recently I talked to a mom whose daughter is struggling with anorexia, and she told me about an appointment they'd had with their pediatrician, who'd been quick to notice the issue and to push for early intervention. The doctor said to the girl, "You need to drink a milkshake every day." Then she added, "But of course, it's your choice."

I've heard this kind of story over and over again, and it makes me crazy. As this mom astutely commented, "Would a doctor ever prescribe an antibiotic for an infection, but then say it was your choice whether to take it or not?"

When it comes to anorexia, way too often the medical profession is willing to settle for inadequate treatment and mixed messages. Would a doctor tell a diabetic it was his choice to take insulin?

"Force-feeding" and anorexia

Recently I've been asked to speak about the Maudsley approach to healing anorexia on several radio shows. In every interview there is a question or comment about "force-feeding" anorexics, and it's always offered in a tone of mingled horror and contempt, as if there could be nothing worse than coercing someone into eating.

To which I usually respond something like, "Actually, there's nothing worse than watching someone compulsively starve herself to death."

Now an interesting paper published in the American Journal of Psychiatry takes on both the moral and legal issues around the idea of what the authors call coerced care for eating disorders. I love the analogy its author, Dr. Arnold Andersen, uses for how dieting can lead into anorexia: "The situation resembles that of a person boarding a canoe headed for Niagara Falls on a journey that begins voluntarily but ineluctably transforms into a nonvoluntary propulsion toward the Falls, with the person at times not recognizing that the upcoming Falls even exist."

That describes it so very well. Someone who is deep in anorexia cannot see the falls or even know they exist. They need the strong hand extended from the shore to pull them out of the current.

Far worse to watch the boat go merrily over the falls.

More on culture and eating disorders

A new study released by the University of Minnesota shows that teenagers who read lots of magazine articles about dieting are five times as likely to practice "extreme dieting measures"--including fasting and intentional vomiting--than teens who don't.

According to an article in the Chicago Tribune, Harvard Med School researcher Alison Field commented, "The articles may be offering advice such as cutting out trans fats and soda, and those are good ideas for everybody. But the underlying messages these articles send are, `You should be concerned about your weight and you should be doing something.'"

This study will come as no surprise to any parent of an eating-disordered child. It describes perfectly the nexus between culture and eating disorders, which is not black and white, either/or. Do magazine articles cause anorexia and bulimia? No, but they clearly, clearly play a role in triggering adolescents who are vulnerable.

And it's not just teen magazines, either. Not long ago on an online forum for parents who are re-feeding their anorexic children, someone started a thread on what triggered each child's descent into anorexia. I was shocked by how many parents mentioned a school health class. And in fact, a 6th-grade "health" class that focused on the dangers of obesity and the virtue of cutting out fats, carbs, and other "bad" foods was the catalyst that led to my own daughter's full-blown anorexia a year and a half later.

As parents, we're used to thinking about all sorts of potentially risky behaviors: drugs, early sexual behavior, alcohol, etc. Now we can add another one to the list.

And yet another Leaden Fork award goes to . . .

Reader's Digest, for its well-meaning but shamefully one-sided advice on how to avoid compulsive overeating. In fact, this could be a primer for how to induce an eating disorder.

Blog reader Deborah Lee brought this to my attention, and points out a couple of items on this top 10 list that really bugged her:

"3. Never, ever buy a snack at gas stations, drugstores, or discount chains.

4. Never, ever stop at a food store just to buy a snack."

Writes Lee, "While I understand the sentiment in these statements, and it may be sound advice in principle, this sort of black-and-white, all-or-nothing thinking is what eating disorders thrive on, and is completely unnecessary."

I'm with you on this, Deborah. Of course Reader's Digest is just one of many media outlets that get this way wrong. Especially in this season, when the default assumption is that we're all trying to lose weight and need "tips" like these. Open just about any women's magazine right now and you'll see headlines like "How to Stick to Your Diet,""Want to lose weight? Be sure not to skip breakfast," and a host of other ridiculous headlines.

I'm looking forward to a year that started without a lot of advice on how to lose weight--and focused instead on creating a healthy and joyful relationship with food, exercise, love, work, and all the other pleasures of being a human being.

How about it?

Listen to the MPR show with Katharine Loeb

The host of the show did a fantastic job--one of the best interviews I've heard or participated in on the subject.

Here's a link to the show.

Talk to me live tomorrow!

I'll be doing a live call-in show tomorrow, Friday, December 29th, 2006, on "Midmorning," hosted by Kerri Miller and produced by Minnesota Public Radio. The other guest on the program will be Dr. Katharine Loeb, assistant professor of psychiatry at Mt. Sinai School of Medicine in New York, and an avid supporter of the Maudsley approach. We'll be discussing anorexia research and treatments, and I'm looking forward to our conversation.

The show airs at 9 a.m. central time. You should be able to catch it online at http://news.mpr.org/programs/midmorning/. Call in with your questions at 651-290-1592.

Talk to you tomorrow!

Is Anorexia Cultural?

That's the $64,000 question. Folks in Brazil are wondering why so many women are dying of anorexia there. Is there something about the culture that is suddenly contributing to a surge of cases? Is the media reporting on anorexia more? What's going on?

More and more, researchers see a genetic component to anorexia and other eating disorders, including chromosomal abnormalities. A 2006 study that looked at anorexia and twins found that genetics accounted for more than half the cases of anorexia, suggesting that people are born with a susceptibility to anorexia and then get triggered during the vulnerable time of adolescence and young adulthood.

Makes sense to me. If culture were the sole culprit, anorexia would be far more prevalent than it is.

Brazil is a country where many people don't have enough to eat; anorexia is typically a disease of "starvation in the midst of abundance." Maybe the rise in prevalence--if there is one--is a symptom of widening gap between the very rich and the rest of the country in Brazil. Maybe it's a sign that the Brazilian economy is improving.

Whatever the statistical explanation, I know one thing for sure: Young women (and men) in Brazil and elsewhere don't have to die. Anorexia can be cured, especially if it's treated early, in adolescence. It's not a cultural metaphor; it's a disease with a tragic trajectory that inflicts a great deal of suffering on anorexics and their families.

Changing the culture, one heart and mind at a time

Last night a friend told me that since my daughter Kitty's illness, her daughter had become very outspoken on the subject of anorexia. She said that whenever other teenage girls joked about it, she "set them straight"--a commendable act of friendship.

But what really made me want to stand up and cheer was when she told me about the day her daughter--Kitty's friend--came home and headed straight for the refrigerator. Apparently someone had told Kitty's friend she looked like she'd lost some weight. "I can fix that," she said, reaching for the whipped cream.

Here's what blows my mind about that: In a culture where all of us are so conditioned to think that thin is always good (and thinner is always better), it's hard to go against the stream. We parents of anorexics are shoved right up against this cognitive dissonance when we re-feed our ill children. It took the gut-wrenching experience of watching my child nearly starve herself to death to open my eyes and change my reflexive thin=good, fat=bad mentality. But Kitty's friend, who is still in high school, is a much quicker study than I am. She's learned from Kitty's nightmare and is already applying the lesson in her own life.

Her insight and perspective give me hope that although change seems to come slowly, it does come, one heart and mind at a time.