No, it's bad news

A couple of days ago I posted about a new study out of Finland showing that anorexia is both--as the media are reporting it--"more common and more transient than previously believed." It took me a few days, but I finally figured out what's bugging me about this: the word transient.

Transient is something that happens for a hour or two and then disappears. Transient is fleeting, momentary, temporary.

Transient is not what happens when the demon of anorexia inhabits someone, body and mind and soul, for three or five or seven years. Transient is not losing most of your adolescence and some of your young adult years to a disease that's like an eclipse of the world-as-you-know-it.

Transient is when they close the street to do construction repairs. Transient is not when the street gets blown up. Even if it gets fixed five years later.

One thing I've learned from Sandy Szwarc is to look behind the rhetoric when it comes to studies and research findings. In this case, it's the interpretation, I suspect, that's bugging me. I don't know if it's the study's authors, or the media reporting it, or both. All I know is that anything that puts a child into hell for longer than an hour or two is not transient. Not at all.

Et tu, Dick Cavett?

My evolution from wannabe-thin-person to fat activist has been a long time coming. And I've lost a fair number of friends along the way, mostly people who for one reason or another could not, cannot accept the fact that people come in all shapes and sizes. Call it fatphobia, call it thin entitlement, call it self-loathing, call it prejudice of the rankest sort. Whatever you call it, it all boils down to judgmentalism.

So I don't know why Dick Cavett's rant in his New York Times blog should feel so especially and particularly mean-spirited and judgmental, but it does. Maybe because I used to like Cavett's TV show. He was witty in a way few other TV hosts were back then. So to have him tell the world now that, 1) it's not OK to be fat, and 2) fat people are "heavily larded folks", and 3) obesity is a "national tragedy," well, it feels like a betrayal.

It's the same feeling you get when you meet one of your favorite writers and he turns out to be an asshat. A nasty asshat who snarls at you, or--and this has happened to me--a sexist asshat who pats you on the head, calls you "doll," and asks for a cup of coffee.

Either way, it's like peeling off the jovial mask and seeing the hard face underneath.

And that's pretty much what Dick Cavett has done. To himself.

Mr. Cavett, you want to see ugly? Take a long, hard look in the mirror. Being thin does not mean being healthy. Being thin doesn't mean being attractive. Especially when such mean-spirited ugliness comes out of a thin person's mouth.

Anorexia: Bad news, good news, bad news

The bad news: A new study from Finland reportedly shows that anorexia is about twice as common as researchers have thought, affecting about 5 percent of the population rather than the 1 to 2 percent incidence rate generally quoted. According to the study's authors, this statistic includes mild and/or subclinical cases not usually counted—people (most of them women) who suffered from "mild symptoms" (the news reports don't say what these are).

The good news: According to this study, about 70 percent of anorexics recover. By contrast, the usual statistics say that about a third of anorexics recover fully, a third remain very ill, and another third stay right on the edge, living a sort of half-life. The mortality rate is 20 percent.

The bad news: That 70 percent of women who recover do it "by age 30," says the study. Given that the average of onset for these women is between 15 and 19, that means they're still sick for many years.

One thing I like about the study is that it describes the arc of recovery in a helpful way: "First, lost weight was regained and menstruation resumed. Attitudes about body shape and weight took a much longer time to resolve. The Finnish study was conducted among pairs of female twins. Twins with anorexia nervosa were compared to their healthy co-twins and to healthy women from the general population. Within five years from weight restoration, women with anorexia nervosa were virtually indistinguishable from their healthy co-twins in terms of psychological symptoms and self-esteem. However, learning to deal with body shape and weight related concerns took usually much longer, 5-10 years."

Still too long. But heartening to know that at least studies on anorexia are starting to funnel down the pipeline.

Maybe the best commentary on the "obesity is contagious" study

And this commentary was published in Poland, where I have no idea what the popular stance is on issues of fat and thin.

Whoever this writer is, s/he gets it and has fun with it. So read up.

Time to spread the love!

My fabulous web designer, Gale Petersen, made a PDF of the I Love My Body! pledge. Yay! So now you, too, can download and disseminate the pledge. Post it at work. Email it to teachers and Girls Scout troop leaders and guidance counselors and parents. It's so easy for us to hate ourselves and our bodies--let's spread a little love instead!

And if you do send the pledge around, I'd love to hear about your experiences with it.

Coming soon: Big Brother is watching you--eat

You've no doubt read about the this article in the New York Times by Gina Kolata, in which she covers the "fat is contagious" study published in the New England Journal of Medicine.

As a fellow journalist, I understand that Kolata had to cover the story. An obesity reporter's gotta cover what an obesity reporter's gotta cover (which is why I left the world of hard news long ago). But the tone of this article is a little too uncritical in my opinion, a little too quick to accept the study's dubious findings as valid research.

The quote that sent me reaching for my keyboard: When a close friend becomes obese, obesity may not look so bad. “You change your idea of what is an acceptable body type by looking at the people around you,” Dr. Christakis said.

In other words, size acceptance causes obesity.

I'm not even going to try to unpack all the assumptions here. Like, for instance,the fact that thin people can become fat, or that fat is always Bad with a capital B, or that it's better to be thin than to be comfortable with yourself, whatever your size is. And then of course there's the fact that these researchers don't seem to understand that--repeat after me, class--correlation does not equal causation.

Kolata certainly didn't try. She appears to have reported all this with a straight face, more or less, despite her considerable knowledge about obesity and scientific research and, well, bullshit.

Gina, Gina, Gina. I may have to take your book off my shelf.

Ellyn Satter's rules for eating

The incomparable Ellyn Satter has posted another newsletter to her website, this one (like the previous two) geared toward helping pregnant women figure out how to eat well despite the growing pressure to not gain much weight during pregnancy.

But these rules apply just as much to those of us who are not (and never will be again!) pregnant, so I'm taking the liberty of summing them up here. Then go read the whole thing yourself.

• Encourage each woman to be positive and reliable about taking care of herself with food
• Emphasize pleasure as a guiding principle in food selection
• Teach and support internal regulation of food intake
• Teach and model body trust

Great rules for mothers-to-be, both to help take care of themselves and to make sure that their attitudes toward food and body image are in good shape as they begin the process of raising the next generation.

If only more clinicians and researchers felt this way.

What is normal?

Not long ago, I had the privilege of being asked to do a radio commentary for a wonderful NPR show called To the Best of Our Knowledge. It aired on June 16 in a show called "What Is Normal?" which includes, among other things, a fascinating description of the Amish ritual of Rumspringa.

My piece was about the difficulty of knowing whether my 14-year-old daughter was going through the "normal" pangs of adolescence or something more serious. If I could figure out how to post the MP3 file here, you could listen to it. Or you can go to to the website and listen to it here. It's a cool show. My piece comes about 24 and a half minutes in.

Now it's women who work who cause obesity

At least according to this article from across the pond, which cites a correlation between between working mothers and obesity that is so specific, it's laughable. According to researchers at the UCL Institute of Child Health in Scotland,

children are more likely to be overweight for every ten hours a mother
worked. This risk increases in the highest-earning families.

They theorize that children of working mothers "have less access to healthy foods and physical activities."

You've gotta admire those obesity researchers--they can find a risk factor in just about anything.

J.K. Rowling and fat acceptance

I love J.K. Rowling. Not just because she's an author of tremendous imagination, heart, and soul, but also for the fat rant that appears on her website. (Thanks to anonymous for the correct link.)

What we know about fat and thin

In response to an anonymous comment made on my last post--don't you love people who attack behind an "anonymous" handle?--I want to clarify a few things about fat and thin.

The biggest cause of fatness is genetics. Heritability for obesity is .7, according to this article in the Proceedings of the Nutrition Society published by Cambridge University Press.

Upward of 90% of people who diet to lose weight gain the weight back and then some. So . . .
Diets don't work.
And . . . when diets don't work, they make people fatter.
Calories in do not equal calories out. (Contrary to anonymous' assertion, this concept does not defy the laws of physics; it's a function of metabolism, which is not uniform from person to person, and which is affected by a wide variety of factors. This not something that I "somehow think"; it's been observed over and over by scientists far more knowledgeable than I.)
Fat people tend to stay fat. (See Kolata.)
Thin people tend to stay thin. (See Kolata, Sims, Minnesota Starvation Study.)
Obesity appears to put people at risk for diabetes.
The relationship between fat/obesity and mortality is much more complicated than fat = bad, thin = good.
The current "moral panic" over fat hangs on a "health and wellness" peg but actually derives more from aesthetics than true health.
Even if we all agreed that fat was bad, we don't know how to make people thinner. See point #1.

And finally:
Fat haters have a lot in common with racists. They may cloak their arguments in other terms, but the bottom line is that they see fat people as ugly second-class citizens who don't deserve to be happy, healthy, or whole.

Now, that's ugly.

The fat wars and eating disorders

I was going to post this as a comment to the last post, but I feel it needs its own thread here.

I'm so sick of hearing that "eating disorders affect a tiny percentage of the population, but obesity kills thousands."

There is ample evidence that obesity does not kill anywhere near the numbers originally released by the CDC. But that's not where I want to go with this today. Even if it were true, this attitude makes me sick. It's like saying, "Losing a few people to e.d.s is worth it, if the rest of the fatties shape up and lose weight."

As some of you know, my daughter almost died of anorexia, an eating disorder that has the highest mortality rate of any psychiatric illness--up to 20%. It's true that diagnosed eating disorders affect only a small percentage of the population—but they are a very real and very significant problem. Especially if it's your child, your niece, your best friend's daughter.

The argument over whether fat is unhealthy or not is not merely an exercise in fat-bashing and prejudice. If it were, well, as someone said earlier, we could indulge in it until the amusement factor wore off and then be done with it. But there are real, heart-breaking consequences to this. And one is that we are now seeing an unbelievably rabid set of anti-fat messages directed at a vulnerable population: kids ages 8-15. Middle school is a time when just about every kid is horribly self-conscious about bodies to begin with. It's also the average age of onset for eating disorders--in the 13 to 15 range. I think we're going to see a rise in anorexia and bulimia as a direct consequence of this messaging. Anecdotally, I know of many families (including my own) whose eager-to-please children started trying to "eat healthy" in middle school and for a variety of reasons (including genetics) went too far and wound up with AN or BN. For those who are susceptible, this kind of pressure will certainly trigger eating disorders.

So this isn't an academic exercise. There is and will continue to be a very real fallout from the "just eat healthy" messaging. Children, families, and adults will suffer. If you've never really known someone with an eating disorder, let me say that you have NO IDEA how much that person suffers. And not just that person, but their family, and friends. Having anorexia is like living with a demon inside you that torments you 24 hours a day, 7 days a week. There is no vacation from e.d.s. They take over your life. You have no life outside them.

And too many of these sufferers will die. Yes, die from eating disorders. And these young women and men are not negligible. They're not collateral damage in (yet another) stupid, ill-advised, mismanaged war. They are our daughters and sons. And I say, enough.

The fat wars

Deja Pseu's thoughtful, informative comment on my last post inspired me to start a new thread, which I've been thinking about all day, between reading and responding to comments here.

Deja asks why it's so much easier for people to accept the realities of a fast metabolism than a slow one. Good question. I think it's like the "career women" (in quotes because that was how they were known at the time) of the 1950s and 60s, at a time when most women didn't have careers outside the home. They were the women who made it by playing hardball with the boys, by becoming one of the boys. They paid dearly for their corporate successes, and they were considered freakish by the cultural norms of the time.

Those women were harder on the next generation of striving career women than any men. Their attitude was, "I had to suffer, sister, and by God, so do you."

And that's what Deja's question, and the whole notion of fat wars, reminds me of. In a culture where thinness confers status, and fatness confers untouchability, of course those who have it, who are thin, will hang on to their notions about it forever. To acknowledge that fat and thin are largely functions of genetics would be to give up that special status. And if you're not a naturally thin person, and you've practically killed yourself getting and staying thin, well, it's human nature to want others to suffer right along with you, isn't it?

Depressing thought.

The war on fat, in someone else's words

I won't say where I found this, but this post was written in response to someone raising the question of whether, perhaps, obesity might not be a completely evil phenomenon:

"Obesity is unhealthy. There is no doubt about it. It increases the risk of high blood pressure, heart disease, diabetes (and subsequent problems with high blood pressure, kidney disease, and major foot problems, including multiple surgeries and amputations), stroke (partly secondary to the high blood pressure), arthritis (from the sheer weight on the joints), plus other medical and psychological problems. When it is also combined with smoking, which it often is, there is even more disaster.

It is a huge expense to society to have so many obese people with their medical problems. It is a preventable disease. People just need to eat less and exercise. They need more self-control.

To flaunt it as a nonpreventable problem is just not true. What has changed during the past 50 years is that people eat more and move less. Obese people want respect for their eating problems and acceptance. I think that as long as other people are able to control themselves and discipline themselves to exercise, then there will be contempt for those that cannot.

Also, I think that a lot of people resent the high cost of obesity. Health care would be a lot less if people just didn't eat double bacon cheeseburgers, fries and a Coke, then go out for ice cream or beer, and then sit and watch TV (or drink more beer, which has a lot of calories.)

Personally, I resent so much money being spent for accomodations and gastric stapling/bypass surgery because people want to gorge themselves constantly with fatty food!"

It's rare to see so many misconceptions and such hatred right out there in the open. Next you'll be telling us that fat people are responsible for global warming.

Personally, I resent the millions of dollars being wasted on ill-directed and ineffective "wellness" campaigns in schools and offices. And I resent the hell out of the ignorant assumptions behind your words.

So I'm going to exercise tremendous self-restraint (and you know how hard self-restraint is for a fat person!) and recommend that you educate yourself rather than simply parrot the anti-obesity rhetoric of our time. Start by reading Gina Kolata's new book, Rethinking Thin. Kolata is a well-respected New York Times science writer. She is also, if it matters to you--and I think it does--a thin person.

Then I'd suggest reading a little Paul Campos--he's also a thin person, though formerly fat. Then read this post at Kate Harding's fantastic blog.

Then come back and tell me how you feel about fat.

News flash: obesity is not a public health crisis

This somewhat circuitous essay by Jay Bhattacharya caught my eye. Bhattacharya is an M.D. and all-around policy wonk at Stanford University's Hoover Institution on War, Revolution, and Peace. (Great name!)

Don't be put off by the offhand judgments Bhattacharya seems to be making early on; the essay becomes more thoughtful as it goes along. His basic premise: obesity is not a public health crisis because it's not contagious, harms only the person him or herself and not others, and, maybe, is not under an individual's control. He makes an interesting point about why fat workers earn less money than thin ones (not because of prejudice, he argues, but because employers "pass through" higher health costs to fat employees); according to Bhattacharya, only fat workers with health insurance earn less. Among those without health insurance, there is no wage gap.

Interesting, but I wonder if the real reason is that the kinds of jobs that don't come with health insurance are so poorly paid that there's no room for a wage differential. Twenty percent less than $20 an hour is significant; 20 percent less than $5 is less so.

The best paragraph in the essay is the last, where he makes a compelling case against setting public policy after jumping to conclusions. Worth a read.

Just for fun--put on your dancing shoes!

Today's New York Times had a story on contradancing and country dancing in the Big Apple.

When I lived in New York City--from 1979 to 1992--this was my subculture. I loved dancing at the church at 13th and Seventh on Tuesday and Saturday nights. It makes me happy to know the dances are still going on. The Times story quoted someone I used to know in the dance scene in New York, Olivia Janovitz. (Hi, Olivia!)

In those days I belonged to a women's sword dance troupe, too. We did things like this.



I miss it! And them.

Self-esteem

Yet another star (in this case, Valerie Bertinelli) is writing a memoir about, among other things, her "lifelong battle with weight and self-esteem."

She's talking about overweight, in this case, and it all sounds so damn familiar: Low self-esteem makes people get fat. It's the same rhetoric that floats around anorexia, which is so often said to be linked to issues of self-esteem. Apparently it works both ways, or both weighs.

Inquiring minds know the truth: Starvation causes all kinds of psychological phenomenona, including depression, anxiety, and, yes, low self-esteem. And being fat in America is an invitation to feelings of worthlessness, inadequacy, and low self-esteem. All you have to do is walk down the street and it flies right at you. Or go to your mother's funeral. Or try to adopt a child.

For once I wish people would get it right. I wish they'd lay the blame squarely where it belongs. In the case of anorexia, that's on biology. And in the case of fat--that's called prejudice.

At risk for what?

This just in: Experts are now urging women to watch their weight before pregnancy and get back to their pre-pregnancy weight quickly after giving birth. Their new recommendations include:

* Body mass index should be measured as part of vital signs at routine annual check-ups and all women of child bearing age should be counseled to achieve and maintain optimal BMI.
* Preconception counseling programs should include education regarding the poor maternal and perinatal outcomes among the obese and overweight.
* Women with high BMI planning a pregnancy should be counseled to participate in intensive nutrition programs aimed to achieve optimum BMI prior to conception.
* Encouraging breastfeeding can partially help to decrease childhood obesity and also help mother to return quickly to pre-pregnancy weight.

Why the panic? Because, say these researchers, "maternal obesity" leads to all kinds of terrible things for babies, including higher C-section rates, "less chance" of being breastfed, obesity later in life, and--I kid you not--"high birth weight."

And here I thought low birth weight was the big risk when it comes to babies and weight. After all, low birth weight can contribute to respiratory problems, cardiovascular problems, infections, neurological problems, SIDS, cerebral palsy, and other medical issues.

But never mind all that. As we should all know by now, it's much worse to be fat than any of those.

I guess they never heard of genetics, and have never read the dismal statistics on weight loss, or followed the studies that show that losing weight if you're fat actually increases your health risks on many levels.

As Sandy Szwarc pointed out in a recent post, there are people who think you can be too fat to love a child. I guess you can be too fat to have a child too.

Tornadoes on NPR

Want to hear a funny story? This radio commentary—on surviving my first tornado—ran on All Things Considered today. Let me know what you think.

Take the love-your-body pledge

The previous post, and some of the comments on it, got me thinking hard about how to begin to change the culture around fat and how we perceive it.

I asked myself: What's the one thing I wish I could change around this issue? The answer: I wish I could change the way girls and women talk to themselves and others about their bodies.

I've posted about this before. And I've written about it in this article. Now it's time to do something about it.

So I have this crazy idea: What if we could disseminate a kind of pledge that young girls and women would sign, promising not to trash-talk about their bodies? Something like this:

I, __________________, pledge to speak kindly about my body.

I promise not to talk about how fat my thighs or stomach or butt are, or about how I really have to lose 5 or 15 or 50 pounds. I promise not to call myself a fat pig, gross, or any other self-loathing, trash-talking phrase.

I vow to be kind to myself and my body. I will learn to be grateful for its strength and attractiveness, and be compassionate toward its failings.

I will remind myself that bodies come in all shapes and sizes, and that no matter what shape and size my body is, it’s worthy of kindness, compassion, and love.


Then what if we got some of their favorite role models to sign, and stand up and say why it's important? Folks like, I don't know, Sheryl Crow and Jennifer Hudson and Mia Hamm? Would you sign it?

See, I think sometimes if you change the story you tell yourself about something, your feelings follow along. So maybe if we change the words we use to talk about our bodies, our feelings about them will follow along too.

And then maybe kids like the 12-year-old in my previous post won't feel so anxious and conflicted about what they eat and how they look. And maybe some of the kids who are genetically predisposed to eating disorders won't develop them.

Maybe it's naive. Or maybe it's a good idea. What do you think?

Overheard at the lunch table

Recently I had occasion to take my kids on an all-day excursion, to which they were allowed to each invite a friend. As we cruised the lunch joint we'd chosen, the 12-year-old friend seemed, well, anxious about what to choose. She wanted nachos, she said, but that wasn't healthy. (Sound familiar, anyone?) Her parents, she explained, have a rule about eating fruits and vegetables at every meal. She finally settled on nachos and a container of cut-up fruit. "My father says I don't eat enough for a girl my age," she commented. Gee, I wonder why; could she be learning from them to be afraid of food? If she has the genetic loading for an eating disorder, she's in big trouble.

As we ate, the conversation turned to a new movie, Ratatouille. This girl had seen it. "I really liked it," she reported, "except for all those rats who were so fat!" Then she went on: "It's so disgusting! They had all these bulges of so much fat!"

I was fairly stunned, but only because she was articulating what I know so many people think. I didn't know what to say, honestly, and what came to mind wasn't great: "In our family we don't feel fat is bad. People come in all shapes and sizes."

"But all they have to do is eat less and eat healthy and they wouldn't be fat!" she cried. Out of the mouths of babes, huh? "That's not actually true," I said, and then changed the subject, feeling like a coward. But I really didn't feel like taking it on, especially since I could see she was just parroting what she'd heard at home.

Later in the day, everyone else got ice cream, and so, I was happy to see, did she. The fruit went home unopened. For what it's worth.

Seeking adults with anorexia for interview

I'm working on a magazine feature for HEALTH magazine about adults with anorexia and am looking for women in their 30s and 40s who would be interested in being interviewed. The original scope of this project was on people who developed anorexia as adults, but it's now changed to women who are still suffering from anorexia as adults, no matter when they developed it.

If you fit the criteria and you've already talked to me, please get in touch again--I lost my records in a computer crash.

If you're willing to talk by phone, please email me off list. I promise it's a sensitively written article, the purpose of which is to help educate mainstream readers about anorexia. God knows they need it!

Anorexia on NPR

A friend called over the weekend to say that she'd been listening to this interview with the author of Peony in Love when she heard interviewer Liane Hansen make a comment about anorexia that made her blood boil. The author was describing lovesick young girls in 17th-century China. Hansen's comment, which comes about 4.15 minutes into the interview:

"It is interesting, the lovesick young ladies that are affected by the opera, what happens to them in their lovesickness is they starve themselves. And that's so much like anorexia, where you have young women today, and young men, starving themselves because that is the only way that they have some control over their own body."

Dear Liane Hansen, you may be an expert on so many things, as your NPR bio indicates, but anorexia is not one of them. Your throwaway comment about anorexia was made out of ignorance rather than malice, I'm sure. But ignorant it was.

Most researchers today believe that anorexia is a biologically based brain disorder. It's not "about" control. It's not "about" bad parenting, any more than autism or schizophrenia are. In fact, it's not "about" anything at all except having the bad luck to be genetically predisposed and to live in a culture full of triggers.

You have a lot of influence, Liane Hansen. I hope you will take this opportunity to educate yourself about anorexia. This website and this website would be great places to start. Then give me a call--I'd love to talk.

PETA's fat-hating frenzy

The folks over at PETA have a gripe with filmmaker Michael Moore: they want him to make a documentary about animal rights.

That's cool. But the way they go about airing their gripe--very uncool.

The president of PETA, Ingrid Newkirk, wrote an open letter to Moore last week, which was publicized on PETA's blog. In it, Newkirk urges Moore to go vegetarian:

"Although we think that your film could actually help reform America’s sorely inadequate health care system, there’s an elephant in the room, and it is you. With all due respect, no one can help but notice that a weighty health issue is affecting you personally. We’d like to help you fix that. Going vegetarian is an easy and life-saving step that people of all economic backgrounds can take in order to become less reliant on the government’s shoddy healthcare system, and it’s something that you and all Americans can benefit from personally.”

PETA's blog goes on to say, "The idea is that if people didn't make themselves unhealthy in the first place by eating meat products that are known to cause heart disease, high blood pressure, and strokes, the situation would easier for everyone. As Ingrid puts it, 'Yes, America’s health care system needs to be fixed, but personal responsibility is a big part of why people look and feel as ill as they do.'"

Take that, Michael Moore! It's YOUR fault if you get sick—and so is the whole crappy health care system in America!

Hoo-wee! It's great to feel powerful, isn't it?

Note to Ingrid Newkirk: Go have a doughnut or something.

One more reason why I'm a fan of family-based treatment

There are very few follow-up studies (or heck, any studies at all) of anorexia treatment, so I was glad to see this one, done in Norway a couple of years ago. I wasn't so glad of its outcomes.

The study was a one-year followup of adult anorexics who'd been treated on an inpatient unit. Of the 24 patients they followed up with, 10 (42%) had improved one year later, while 14 (58%) had "poor outcomes."

I'm grateful that they did the study, frankly, because most of the numbers on inpatient anorexia treatment come straight from the clinics and units, which often stand to make a tidy sum on treatment. Their followups are usually done at discharge, so they don't take into account what almost always happens after that: relapse and rehospitalization.

So bravo to the researchers in Vikersund. And chalk up another reason why family-based (Maudsley) treatment is an excellent option for anorexia.

"Who *doesn't* want to lose 20 pounds?"

That's what ex-supermodel Rachel Hunter said in New York magazine about her new gig as spokeswoman for Slim-Fast. She was admitting that she'd never tried it.

This kind of fat trash talk is my least favorite. It's the equivalent of the air kiss, the baring of the throat by the subordinate animal. It's a social custom denoting (supposedly) good taste and submissive femininity. The words themselves aren't the point; it's the intention behind them. And the intension is to erase the self, to make yourself as small and thin and weak as possible.

20 pounds = the weight of 7 brains
20 pounds = the weight of my older daughter at age 11 months
20 pounds = the number of pounds I lost on my first diet, age 15
20 pounds = the number of pounds I lost on my last diet, age 29
20 pounds = the amount of weight lost by my mother in law in the month before she died of cancer

But who doesn't want to lose 20 pounds?

**Thanks to Maggie! for sending this item my way

Another book the world doesn't need--gulp!

Thanks to Kate Harding for posting about the latest entry in the fat hatred sweepstakes--a joint project from two of my former favorite children's book authors. The book is The Gulps, and it features a lazy, gluttonous family who are constantly eating junk food and watching TV. Just like all the fat people I know in real life!

The Gulps was written by Rosemary Wells and illustrated by Marc Brown (of Arthur fame). May it die a speedy, painful death and be remaindered as quickly as possible.

This is what dieting can lead to

This excerpt from a brave, honest livejournal entry, addressed to the "pro-ana" contingent, made me cry. Of course not everyone who diets will become anorexic. But everyone who becomes anorexic goes through this. It's heartbreaking. It's lifebreaking.


"I have anorexia.

Not 'pro-anorexia,'
Not a strict weight loss obsession.

The last 6 months of my life have been hell.

I have watched everything I love slowly deteriorate around me, my own little world be turned completely on its head. I have damaged myself beyond repair and hurt those i love time and time and time again.
And I cannot control it.
Because it is a disease.
It is a condition.

And right now, it's very very bad for me.

I cannot express my frustration with those people who exploit the anorexic condition by using it to starve themselves as a weightloss strategy.
I want to eat.
I want my life back.
Anorexia stops me.
I'm fighting it, but it's hard. the hardest thing I've ever done.
How dare you all, sit there and wish for this.
Get out now while you can.
Please. I wish I could."

More research on anorexia . . . I think

I'm a big supporter of more research about anorexia. If you've read my blog or articles you know I think one of the reasons we don't have better treatments is lack of good research. So I'm always excited to see a new study come out.

I have to admit, though, that the title of this one--"What is worse for your sex life: Starving, being depressed, or a new baby?"--reminded me of the kinds of questions you ask your friends when you're in middle school, like "Which would you rather do, burn to death or freeze to death?"

Still, I guess it's a good thing to have the redoubtable Cynthia Bulik involved in a new study, whatever the topic. After all, she's at the forefront of the research on the genetics and biology of anorexia.

Oh, and if you're wondering, the answer to the question the study poses is that it's better to have a new baby.

Shame on you, Dear Abby

I'll cop to reading Dear Abby, despite the often off-the-mark advice she doles out. But today's column went beyond off-the-mark and into just-plain-dangerous-and-wrong territory.

Here's the letter in question: "I'm an attractive, single, successful, 27-year-old woman who has struggled with anorexia ever since I was 12. I have learned to live with it and feel no need to advertise it to the world. However, I find that many strangers, including a large number of people I associate with at work, feel a compulsion to comment on my weight (105 pounds and 5 foot 9), the size of the clothes I wear, or what I eat. It's as uncomfortable a subject for me as I imagine it is for people who are overweight, and I have no 'pat' answer for them." --Annoyed at 105

Here's Abby's response:
Dear Annoyed: Clearly, your weight issues are more obvious to those around you than you chose to believe. However, you are under no obligation to answer these intrusive questions if it makes you uncomfortable. When confronted, reply, "That's a very personal question (or subject) and I'd prefer not to discuss it." Then change the subject.


Argh! Please write to her and set her straight about anorexia: It's not a "lifestyle choice" but a lethal mental illness. Ask her why she would sanction this writer's settling for a life distorted by anorexia. Invite her to list resources that might be helpful to "Annoyed" and her family, including maudsleyparents.org, NEDA, eatingwithyouranorexic.com, and others.

This is a teachable moment on a national scale. Go for it!

Couldn't resist this one, either

Check out this satire on all the "war on obesity" news of late. Hee hee.

Because I can't resist . . .

You won't be able to, either. It's a musical love letter from a young Brit to the "big girls," and it really rocks!

"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.