Ludicrosity

This new "study" deserves its very own made-up word--that's how utterly ridiculous and misleading it is.

It's a classic case of distortion, from the headline--"Obese? Drive at Your Own Risk!"--to the bait-and-switch of its conclusion. Based on research involving people in car accidents, it purports to look at how BMI affects your risk of dying in a car accident.

Here's how it opens:

Being obese may increase the risk of perilous diseases like diabetes, heart attack, stroke and cancer. And it can be fatal in one more way -- it enhances the risk of dying in a car crash.

What's the connection? Well might you ask. This is one of those reviews masquerading as a study, where researchers look at data--in this case, data on people involved in car accidents and their BMI.

Researchers divided over 230,000 people into groups based on their body mass index (BMI) . The rate of always wearing seat belts was 82.6 per cent for non-obese motorists (BMI less than 25), 80.1 per cent for overweight motorists (BMI 25-29), 76.6 per cent for obese motorists (BMI 30-39) and 69.8 per cent for extremely obese motorists (BMI 40 and above). The gap climbed from 2.5 per cent for overweight, to 6.0 per cent among the obese, to 12.8 per cent among the extremely obese.

Um, what we've got here is a correlation between not wearing your seat belt and dying in a car crash, along with a statistical analysis of percentage of seat belt wearers and their BMI.

As Sandy Szwarc is fond of saying correlation is not causation. Or, to put it another way: The media is willing, but the evidence is weak.

Practicing with a license

I've given serious thought to going back to school and getting an MSW so I could get licensed as a therapist and work with people who have eating disorders. I've often felt this year like I was practicing without a license--giving therapeutic advice while not being a therapist or having any medical training myself--and wondered if I should get some training.

And I probably will get more training, at some point. But this advice column reminded me that a license doesn't necessarily mean that a) you know what you're talking about, or b) you give good advice.

It's written by someone with an MSW who displays appalling ignorance about eating disorders and the state of treatment. She sounds a lot like the first therapist we saw when my daughter was diagnosed with anorexia. A mother wrote in about her young daughter, who she believes is showing signs of anorexia, and this social worker responded by, first, pooh-poohing the mother's sense of her daughter's health:

Though child anorexia is now being diagnosed in girls as young as six years old, my gut tells me that it’s not the case here. X's weight is stable, and girls suffering from anorexia usually exhibit a rapid and profound weight loss.

Wrong, wrong, wrong. That's what I thought when my daughter got sick, and because she hadn't lost a lot of weight, I figured she couldn't have anorexia. In fact with children and adolescents the issue is often a failure to gain weight rather than a dramatic weight loss. When you weigh only 70 pounds to begin with, it doesn't take much to tip you into a state of malnutrition.

The therapist goes on to say that

Anorexia, which is an eating disorder, is linked to an emotional problem. It is not about food, but rather about feelings. These are often feelings of intense levels of tension and anxiety, or an inability to cope with one’s surroundings. It’s complicated, and it’s certainly not something that most parents would be qualified to “fix.”

Wrong again on every count. As readers of this blog already know, the latest research on eating disorders shows that they are biological illnesses--brain disorders. The head of NIMH has gone on the record saying so. And while they surely are complicated illnesses, there's no one in a better position to help "fix" them than a parent, because the treatment is food. Not psychobabble*. Not circular discussions about feelings. There may be value in therapy, but later on, when the brain is nourished and working properly again.

I guess having a license doesn't mean you know what you're talking about. And not having one doesn't mean you don't. I won't be going back to school but I'm going to keep on trying to educate families and professionals about the realities of eating disorders until the so-called professionals get a clue.


*Apologies to my therapist friends. I'm a big believer in therapy--just not for someone who's acutely malnourished. Food first, talk later.

Would you rather be fat or live another 20 years?

Readers of this blog have no doubt heard about the study* that showed a shockingly high percentage of people would rather be blind, lose a limb, live a shortened lifespan, and suffer other calamities--so long as they didn't have to be fat.

Now a new study may put that fatphobia to the test. Researchers at the Fred Hutchinson Cancer Research Center in Seattle have found that nematode worms who were exposed to one of the tricyclic antidepressants lived up to 30 percent longer lifespans. Their hypothesis: the drug disturbed the balance of chemicals in the brain and created a "perceived, but not real" state of starvation that altered the creatures' natural lifespans.**

Sounds like sci fi, doesn't it? After all, humans have been chasing a longer lifespan since Ponce de Leon hunted for that fountain--and probably long before that. But wait, said the researchers, even if this effect could be shown in people, they're not going to go for it, because that class of medications causes "weight gain and increased appetite."

So someday we really might be faced with a choice between being fat and living significantly longer.

What would *you* do?

*See www.yale.edu/opa/newsr/06-05-16-02.all.html
** See www.news-medical.net/?id=32859

Want to lose weight fast?

Carrie over at Ed-Bites has some brilliant ideas for you.*



*Please note: My tongue is inserted firmly in my cheek.

Mom's off the hook, Dad's on the hot seat

For the last 60 years or so, parents have been blamed for their children's eating disorders. Doctors have believed, and said, that anorexia and bulimia are caused by overcontrolling parents, by abusive parents, by sexual trauma, by inattentive parents, by cold parents, hypercritical parents. New research on the biology of eating disorders has slowly begun to offer an alternative to the blame game--a combination of genetics, biology, and environment is probably responsible for eating disorders, or so goes the latest thinking. (Though some folks clearly have some catching up to do on this score.)

Now a study from Australia points the finger once more at parents--specifically fathers, who are charged with contributing to a child's anorexia when they exert too much control. Mothers, on the other hand, played no apparent role.

I haven't read the original study, but the article reporting it makes me wonder how, exactly, this data was gathered. Reading between the lines, it seems the descriptions of the paternal relationships were reported by the teens with anorexia. Well, they'd have to be, wouldn't they?

Anyone who's parented a teen with anorexia knows that someone in the grip of an eating disorder may reflect a lot of anger toward parents, especially if those parents are insisting that the teen eat. It's really not the teen talking but the disease, which famously warps perceptions and behaviors.

While I'm sure there are overcontrolling fathers out there who contribute to their child's unhappiness in various ways, I'm a little leery of this kind of thing being reported as fact in a scientific study--and of what may come of it down the line.

As Daniel Le Grange once pointed out to me, by the time families come in for help with a teen's eating disorder, they tend to look pretty overcontrolling, because they're terrified at their child's behavior and frightened for her/his health and life. So even if the observations are made by someone outside the family, I wonder how meaningful observations made in a time of family crisis really are when thinking about causation.

God knows we need more studies about anorexia and bulimia--the lack of them is in part responsible for the dreadful lack of effective treatment options. I just wonder if this is the best use of research dollars. Wouldn't the money and time be better spent looking at ways to help teens recover rather than blaming their parents?

Um, just a thought.

O.M.G.

That's about all I can say right now about this destructive, damaging, obscene board game meant for preschoolers. It's about as subtle as a fart gag, and about a million times more noxious, because it seems designed to turn young children into budding anorexics.

The incomparable Sandy Szwarc had a lot to say about this today. As she points out, "[The game] teaches that foods, especially “bad” foods, make them fat. The message illustrated is that when a food is eaten, they must purge by expending a certain number of calories in exercise to avoid getting fat. Calorie counting before they can count."

The game reminds me of another ill-advised project of the last year, the inexplicable collaboration between two of my favorite children's authors on a book demonizing fat people and making plenty o' assumptions about them.

May Hungry Hank go the way of The Gulps. And fast.

Talking to middle school staff

Yesterday I made the first of what I hope will be many presentations to middle school staff--at my younger daughter's middle school, because that seemed like a good place to start. I'd put together a PowerPoint on 6 things I wanted them to know about eating disorders and 8 ways they could help.

The group was smaller than I'd hoped for, but they were really engaged. These are people who do truly care about the lives of kids. I was very heartened by that. Like doctors, they don't get any special training in eating disorders, and they're often frustrated and frightened by what they see.

I was also heartened by a conversation we got into on the "wellness" curricula--the same cockamamie stuff that bans syrup from elementary school lunchrooms and forbids a second slice of pizza to 4th-graders. One of the messages I tried to convey was how the increasing and heavy-handed emphasis on "eating healthy" and the war on obesity as played out in the schools was likely to trigger more eating disorders. It certainly sends a screwed-up message to kids and disrupts their lifelong relationship with food and eating. I'd braced myself for pushback along the lines of "Well kids are unhealthy and it's our job to help them learn to control themselves!" Instead, I got lots of nodding heads and comments about how worried they, teachers and staff, are about the shrill curriculum.

That made me feel good. There is room to broach these subjects, in public, and to begin a dialogue on them. Nothing changes if we just sit at home bitterly blogging about this stuff. We've got to get out in the real world, say our piece, and talk about it.

Syrupgate

It all started innocently enough, with a 4th-grader and a school lunch. Said 4th-grader was having the school's hot lunch that day--French Toast Stix [sic]--and mentioned to her mother that maple syrup was no longer served with this, um, lunch, thanks to the new "wellness" policy in our school district.

So Mom sent along the tail end of a bottle of maple syrup with 4th-grader. And Mom got a phone call the very next day, reminding her that it is not OK to send in maple syrup, which is now apparently considered a controlled substance in the lunchroom.

Of course, I can see why maple syrup would be banned from an elementary school lunchroom. It's way too unhealthy to be eaten by children. And it no doubt contributes to the Obesity Epidemic! Whereas serving deep-fried bread sticks--or stix--does not.

No less a personage than the principal herself got involved in Syrupgate, because there's nothing more important than our children's BMIs (I mean health).

It's the same ridiculous pseudo-reasoning that limits all children in elementary schools here to one and only one slice of pizza on pizza day. Have you ever seen an elementary-school-size slice of pizza? It wouldn't fill a rat's stomach for an hour, let alone the stomach of a growing child for the rest of the afternoon.

Two slices of pizza and a swig of maple syrup might satisfy the children's hunger . . . but it might also Make Them Fat. And we all know it's better to be hungry than to be fat, right?

At least in my town.

"Mom, I'm too fat!"

These are the words to strike terror into a mother's heart, especially if you've ever dealt with anorexia or bulimia in your house. Every child or teen with an eating disorder says these words at one time or another. They reflect the delusion at the heart of an eating disorder, the distorted perceptions of her/his own body and the anguish caused by those distortions.

I heard them many times in the year my older daughter was sick with anorexia. But this time, this weekend, they were uttered by my younger daughter.

My younger daughter sat with us at the table during the year and a half of re-feeding. She lived through the horror and terror of it all with us. We tried to protect her from the worst of it, but she certainly experienced firsthand the nightmare of living with an eating disorder. This may contribute to the reality that as the sibling of a child with anorexia, she's 8 times more likely to have it than other kids her age.

And we've talked about it. Boy, have we talked. We've talked about unrealistic body images and the media. We've talked about food-as-fuel. We've talked about bodies-come-in-all-shapes-and-sizes. We've talked about health-at-every-size.

I thought we'd talked our way through the dangerous parts and onto the solid shores of reason and understanding.

But the trouble is, as my younger daughter informed me, I just don't understand. I don't understand what it's like to be in 7th grade and be a girl. I don't understand what it's like to be a year or two behind when it comes to puberty, to still have a child's body, a child's shape, in a world full of budding young women.

"They look like this, Mom," she cried one night this weekend, sucking in her stomach to show me. Whereas my younger daughter still has the round shape of a child. She's younger than everyone else in her class, shorter, and clearly going through puberty later.

I don't think other kids are making fun of her for her childish figure. I think this is a case of institutionalized self-loathing. But I don't know for sure. I do know that seventh grade girls diet. A lot. And that they talk about their diets. And they talk, as young women (and some young men) do, about how fat they are.

They talk about how fat their butts and thighs and stomachs are. I know these kids; I've chaperoned them on field trips and come into their classrooms for years. They are not fat. They are not the headless fat children whose photos you see accompanying every media scare on the subject of childhood obesity. They look no different from kids of my generation, except that maybe they're a little taller.

Even if they were fat, of course, it would make no difference.

These children are bombarded with media images of super-thin women and men, and so that body type and paradigm comes to look very normal to them. They watch a lot of TV and movies and they learn to see themselves as sexualized from an early age.

They're bombarded at school with hysterical warnings about body fat and obesity and unhealthy eating. They are forced to watch Supersize Me. They are weighed and their BMIs calculated, in front of other children. Their body fat is "measured" (however inaccurately) with calipers, all in front of other children. They are taught that there's good food and bad food, that some foods are unhealthy, that some bodies are unacceptable. They're taught that you can never strive hard enough to be thin, to exercise, to avoid certain foods.

Some of them develop eating disorders. Maybe they would anyway; there's no way to know. We do know that some kids come hard-wired to be susceptible to an e.d., and that those disorders can then be triggered by environment and other factors. So maybe if they grew up in a culture that wasn't obsessed by issues of weight and body size and shape, they would pass through the dangerous time of adolescence without ever developing an e.d. If they grew up in a culture where it was OK to be who you are--fat or thin, intellectual or street-savvy, funny or serious--they would come out of adolescence loving themselves, not hating who they are.

Maybe this is all wishful, deluded thinking on my part.

I do know that those words my younger daughter said struck pure terror into my heart. That we will be talking about this from every direction I can think of over the next few months and years. That I'll be watching her like a hawk for the first inklings of an eating disorder, watching with terror a lump in my throat, with the memories of my older daughter still fresh, and with the determination to do whatever it takes to save her if she is in fact in danger.

But my god, how I wish I didn't have to. It occurs to me for pretty much the first time how different this would feel is the culture supported me rather than fought me. But in this culture and time, to advocate for, as Ellyn Satter says, a "joyful, comptent relationship with food," is to swim against the current, to fight the mainstream, to be perceived in many ways and places as a nutcase, a fruitcake, a mom-with-an-agenda in the worst possible sense of the word.

I've developed a thick skin. I don't care what the powers that be think. I care only about my children, and other people's children. But it's so easy to buy in to the culture's sick obsession. So easy, in a certain way, to turn to my younger daughter and say, "You do have a little tummy, dear--why don't we go on a diet? Together?" To unwittingly set her up for either a lifetime of physical self-loathing or disordered eating, or the hell of a full-blown eating disorder.

Not today. Not my daughter.

Media misunderstandings

I suppose I should be glad that my local newspaper is covering eating disorders in this article on a 41-year-old woman with bulimia.

But you know, it's hard to feel encouraged when you read lines like this:

Thanksgiving, challenging for anyone on a diet, is particularly problematic for people with eating disorders, whose troubles with food generally stem from deep psychological issues, therapists say.

There's a whole lotta sloppy thinking and reporting packed into that one paragraph. For one thing, it conflates "anyone on a diet" with "people with eating disorders," as if an eating disorder was the same phenomenon as a diet, only taken to an extreme.

And of course the line about "deep psychological issues" is just the same old b.s. we've been hearing since Hilde Bruch started writing about anorexia.

We know a hell of a lot more about these diseases now than Bruch did. We know they're biological illnesses. We know that genetics plays a huge role. And we know that you don't need "psychological issues" to develop anorexia or bulimia.

SOmeone who's lived with an e.d. for 20-some years may well have "deep psychological issues" with food. But it's a chicken and egg thing. The illness comes first, the "issues" come later.

The article goes on to describe how the woman with bulimia has been hospitalized seven times (six times at Rogers Memorial) for her eating disorder and still struggles with it. The tone smacks of prurience--"She actually might get up from the Thanksgiving table and vomit!"--and the continued conflation of eating disorders and dieting leads to comments like "Therapists encourage people with eating disorders — and anyone with more routine concerns about overeating on Thanksgiving — to plan ahead. Consider what items might be served and decide how much of each you'll eat."

Um, that sounds exactly like eating disorder talk to me.

It's all about the food

I love this article, which talks about new research showing that when it comes to getting nutritional bang for your buck, it's food itself rather than supplements, vitamins, etc. that holds the key.

The article refers to recent studies that have looked at whether ingesting specific nutrients--B vitamins and beta-carotene--can prevent heart disease, cancer, and other ailments. All of these studies so far have shown no value, or even a slight negative value, to the supplement approach.

These researchers argue that it's the food, not what's in it, that's good for us. Sitting down to a plate of steamed kale with olive oil and garlic is an entirely different matter, nutritionally, than dosing yourself with B-vitamins, iron, etc. This follows along with conclusions from a 1970s study showing that when you enjoy what you're eating, you actually get more nutritional value from it. Shocking!

Here's the money quote in my book:

[Researchers] focus on the concept of food synergy - the idea that more information about the impact of human health can be obtained by looking at whole foods than a single food component (such as vitamin C, or calcium added to a container of orange juice).

Just as some of us have been saying all along, food is medicine.

So on this Thanksgiving week, lift a fork in honor of the pleasures and privileges of food. Say thanks to your body, a splendid machine that knows how to make use of food, and to your taste buds, which let you enjoy it.

Then dig in.

The obesity paradox, redux

In the category of why-is-this-so-hard-to-believe, Reuters reports that the effects of the so-called "obesity paradox" have prevailed in yet another study, this one on people with heart disease and high blood pressure.

The results substantiate earlier results showing the now-famous J-shaped mortality curve described by Dr. Katherine Flegal, wherein overall mortality rates are highest at either end of the spectrum and lowest in those in the "overweight" category. What's significant about this study is that it concentrated on people with heart disease--who are, if you listen to the media at all on this subject, in imminent danger of death if they carry even a couple of "extra" pounds.

This study of 22,576 people with high blood pressure and coronary artery disease found that

compared to normal-weight subjects with a BMI between 20 and 25, the risk of death, heart attack, or stroke was lower in subjects who were overweight (BMI 25 to 30), and in those with class I obesity (BMI 30 to 35) and class II-III obesity (BMI 35 or greater).

The article is accompanied by--what else?--the obligatory shot of headless fatties. And its wrap-up leaves something to be desired:

In a commentary, Dr. Carl J. Lavie and colleagues of the Ochsner Medical Center, New Orleans caution that while improved outcomes appear to be consistently associated with increased BMI, "one should not conclude that weight reduction is detrimental in overweight populations."

I'm not sure what we should be concluding then, except that the media coverage on this subject is, as usual, beyond biased.

And the next Leaden Fork award goes to . . .

Dr. John Tickell, billed as an "Australian expert in nutrition and weight control," for his passionate campaign to charge obese airline passengers extra for being fat.

"Airlines are buying fuel, and if you are carrying a heavy weight on a plane you have to pay more for it. But instead, the rest of the public is paying for it. It's got to be restricted," said Tickell.

Uh-oh. Do I hear the sound of thin entitlement?

Tickell went on to greater heights of hyperbole with this comment: "Flight attendants in the US have to go down the aisle handing extension seatbelts out like headphones."

Maybe he'd prefer that fat people didn't wear seat belts on a plane. Maybe some bruises and broken bones in case of turbulence would open our eyes to the fact that , golly, we're fat!

Turns out Tickell is ticked off because he was once charged $100 to check golf clubs, while a passenger who "outweighed him and his golf clubs" didn't have to pay extra.

Maybe security should just require surgical removal of excess fat at the checkpoint. That would solve the problem, right, Dr. Tickell?

What we all can do

A young woman I didn’t know died last week. She was bright and talented and had many interests—acting, writing, music. She wanted to teach and have a family when she grew up. Only she’s never going to grow up.

I didn’t know this young woman, but I know the kind of disease that killed her, because it nearly killed my daughter. We don’t talk about these illnesses much. We don’t talk about the fact that one of them is the deadliest psychiatric disease, or that it kills 20 percent of its victims and makes life hell for the other 80 percent—for a year, for five years, forever.

We don’t talk about it because so many people still think that people with these diseases are spoiled rich kids acting out, looking for attention, or trying to punish their parents. They think these illnesses are a lifestyle choice, and they can’t imagine why anyone would choose it.

The diseases are eating disorders. The reality is that people don’t choose them and can no more choose to recover from them than you can choose to cure yourself of cancer.

I don’t know this young woman’s family, but I know something of what they’ve gone through, because our family went through it, too. Lots of families in my community have gone through it, but few will talk about it. They don’t talk about how an eating disorder steals a teenager’s life, or how insidious it is, and they sure as hell don’t talk about how deeply ashamed and guilty they are about their child’s illness.

There are doctors and nurses in my community who still blame families when a child has an eating disorder. Who will tell you, with a look of disdain, that you did this to your child. You’re the reason your child weighs 70 pounds and is too weak to sit up in bed. You’re the reason your bright, charming, funny child can do nothing but shake and cry and still, even though she’s starving to death, cannot eat. You're the reason your National Merit Scholar throws up everything she eats. It’s because of you that your child has died, because you’re too smothering, too cold, too enmeshed, too anxious, too controlling, too permissive.

The latest research on eating disorders clearly shows that genetics and biology are the biggest risk factor for an eating disorder. But we as a society haven’t caught up to scientific reality yet. We still blame families, the way we used to blame them for autism and schizophrenia and homosexuality. We still brand them with a devastating stigma.

And as long as this shame and stigma prevail, other young women and men will suffer and die. We need more effective and more evidence-based treatments for eating disorders, and one reason we don’t have them is because so little research has been done. And one reason for that is that so few parents are able or willing to step up and become advocates for their children. The stigma and shame are too great.

We can do better than this. As a community, we can come together around a family struggling with an eating disorder the way we come together for families struggling with cancer or other terrible illnesses. Our children need compassion and empathy. They need us to understand that they don’t choose to have an eating disorder and they can’t unchoose it. They need and deserve better treatments and more understanding.

I cried when I read this young woman’s obituary. I cried for a girl I will never know. I cried for my daughter and for all the young women in this community and elsewhere who are battling the demons of an eating disorder.

My tears won’t change a thing. But I’m hoping my words will change the way you think about anorexia and bulimia. And the next time you hear about a child who’s been diagnosed with anorexia or bulimia, instead of wondering what went wrong in that family, you’ll wonder instead what you can do to support them through the most terrible and difficult time of their lives.

In the category of "We coulda told ya"

comes this story from the International Journal of Obesity, which reports that there's something even worse for you than being too fat or too thin: thinking that you're too fat or too thin.

According to the article,

. . . individuals with overweight or underweight perceptions have an increased chance of experiencing medium (40 per cent and 50 per cent, respectively) and high levels of psychological distress (50 per cent and 120 per cent, respectively).

By comparison, being fat or thin in and of themselves were

not associated with psychological distress.


According to lead researcher Dr. Evan Atlantis from the University of Sydney, "weight perceptions that deviate from societal 'ideals' are more closely and consistently associated with psychological distress than actual weight status, regardless of weight misperception."

In other words, to misquote Maria Muldauer (and to make an unforgiveably bad pun), it ain't the meat, it's the emotion.

Atlantis went on to say, "Our findings suggest that public health initiatives targeting psychological distress at the population level may need to promote healthy attitudes towards body weight and self-acceptance, regardless of weight status."

Yup. We coulda told ya that. But it's nice to hear it from someone in the science community anyway.

Boycott this company

for its repulsive and unfunny Halloween costume glorifying and romanticizing the most lethal psychiatric disorder there is.

Write them a letter: 3WISHES.COM, Inc. 2144 East Lyon Station Road, Creedmoor, NC 27522. Better yet, call them on their own toll-free line: 800-438-6605.

Despicable.

New York Times blogger Judith Warner wrote recently an interesting post about migraines and her attempts to get off medication for them. Her new approach included an extremely restrictive diet, which eliminated coffee, chocolate, MSG, nuts, vinegar, citrus fruits, bananas, raspberries, avocados, onions, fresh bagels and donuts, pizza, yogurt, sour cream, ice cream, aspartame and all aged, cured, fermented, marinated, smoked, tenderized or nitrate-preserved meats.

It sounds something like the diet I went on when my children were very colicky babies, which cut out everything worth eating and left me, as Warner writes about herself,

ravenously hungry, cranky, spaced out and vaguely, deprivedly resentful. . . . But . . . once I got used to it, I came to almost enjoy being on my diet, exploring my capacity for hunger and self-abnegation, obsessing over what foods I could eat, and how, and when. At the very least, the diet made my friends happy. Renouncing food, renouncing pills, is so often, in our time, seen as the right and righteous, pure and wholesome thing to do.

That's certainly what I experienced on the colic diet: a sense of pride and self-righteousness that almost made it all worth it.

Knowing what I now know about eating disorders and how crucial reinforcement is in creating the feedback loop that sustains them, I wonder whether any kind of restrictive diet can put you into that mindset. Maybe if Warner or I were genetically susceptible to eating disorders, we'd have developed them.

It makes me even clearer that dieting is not a good idea, especially for teens, who are most vulnerable to the development of an eating disorder. Better to stay away from that kind of reinforcement.

For the record, Warner writes that while the migraine diet helped for a couple of weeks, it failed to cure her migraines. So she's back on meds and back to eating a more normal diet. Good for her.

One hospital that gets it

I'm deeply encouraged by a new study from the Children's Hospital at Westmead, in Sydney, Australia, where in 2002 clinicians set out to reduce the rate of readmissions and relapses they were seeing on the eating disorders ward. They began offering the Maudsley method for families with children and teens being discharged, and saw their readmission rates drop significantly.

They also identified four "practice challenges," aspects of treatment to pay attention, and I think three of them are worth repeating here because they get to the core of the challenges of family-based treatment.

1. Parallel process, or getting families and treatment providers on the same page. "Failure to achieve this tends to replicate the dynamic seen in a split parental team and leads to conflict, confusion and treatment failure," wrote the study's authors.

2. The therapeutic relationship with the family. "The therapists connection with the parents plays a significant role in helping them remain focused and energized for the task at hand. . . . The relationship for single parents with the therapist and supporting team is particularly significant, taking on an important role of emotional support that parallels the support that parents would give each other in an intact family."

3. Difficulty in predicting which families will succeed. "Clinicians need to maintain optimism and faith in a family's capacity, regardless of how they present."

Parents, if you're looking for treatment for your child, I hope you'll keep these important lessons in mind. Don't be afraid to bring them up with your treatment team.

5 Things You Should Never Say

We've talked about the kind of corporeal self-loathing that's become institutionalized in American culture, especially among women. We've promised to try to love our own bodies. (Right?) Now let's take all that a step further and think about the kinds of things we say to one another about the way we and other people look.

Here's my vote for 5 things you should never, ever say to anyone. No matter how thin or fat s/he is. No matter how much you really want to. Because not one of these comments is helpful, and some are harmful--to you if not to the other person involved.

1. You look great! While there's nothing wrong with a sincere compliment, this is typically not sincere. It's usually code, meaning either You look great, you've lost some weight! or You look great even though you're still fat! Try, instead, something specific, like I love your hair like that. Better yet, skip the comments on other people's appearance and find something more interesting to talk about.

2. I never eat X. Maybe you're a vegetarian who hasn't eaten meat in 20 years. Maybe you're allergic to chocolate. Or maybe you're caught up in the good food/bad food syndrome, where the demon du jour is carbs or fat or whatever. My advice: Keep your food tics to yourself. Better yet, get over them. Learn to love your body and respect the fuel that keeps it going.

3. I guess you got the thin genes! This comment was actually directed to my daughter by a salesperson. I was the one shopping; I'd just come out of the dressing room with an outfit on. My daughter had recently been diagnosed with anorexia and was emaciated and awful looking; she was with me that day because she was too anxious to be home alone. This salesperson managed to insult both of us with one comment. I haven't shopped in that store (which used to be one of my favorites) since.

4. Aren't you worried about your health? Translation: You should damn well be worried about your health, you fatso. Given what we know about the tenuous to nonexistent relationship between weight and health (see Sandy Szwarc's righteous columns, Paul Campos' writings, Gina Kolata's book, and other up-to-date treatments of this subject), this comment is outdated and ineffective. And just plain cruel.

5. I wish I had a little anorexia! Do I need to tell you why this is a stupid, cruel thing to say? I don't think so. You realized that the minute it came out of your mouth.

Now that you've developed your inner editor, here's one thing you can always say: I love you. Repeat as needed.

National Love Your Body Day

In honor of National Love Your Body Day, I want to remind my readers to take the "I Love My Body" pledge.

Then check out the Love Your Body show.

Then do something fun for your body today--take a walk, eat some chocolate, go dancing,sunbathe (well, not if you live in Wisconsin). Be kind to your body and yourself. Doctor Harriet's orders.

Attention chocoholics

According to this study, there are two kinds of people in the world (metabolically speaking): chocolate lovers and those who are (can it be?) indifferent to chocolate's virtues.

The idea behind the study, frankly, smacks a bit of Big Brother:

This study by Swiss and British scientists breaks new ground in a rapidly emerging field that may eventually classify individuals on the basis of their metabolic type, or metabotype, which can ultimately be used to design healthier diets that are customized to an individual's needs.

I'm not sure I want to go there, or anywhere where someone is going to design a "healthier" diet just for me. Been there, done that (Weight Watchers, 1974).

Still, if it included chocolate, maybe it wouldn't be so bad. . . .

Bet you won't see any mainstream news stories about this

And by "this" I'm referring to the results of the biggest clinical trial of healthy eating ever, as reported by Sandy Szwarc over at Junkfood Science. We're talking about part one of the Women's Health Initiative Dietary Modification Trial, which posted results like these:

• Healthy eating had no effects on rates of cardiovascular disease.
• Healthy eating had no effects on rates of breast or colorectal cancers.
• Women who followed a "healthy (lower-fat) diet did not wind up thinner.
• Women who didn't "watch what they ate" and ate more fat and calories didn't wind up fatter.

Did you read any news stories about this? Me neither.

Results from Part II are about to come out. I can't wait to not read those, too.

Stick it to Ed (musically)

One of the great pleasures of the NEDA conference for me was meeting Jenni Schaefer, author of the book Life Without Ed. Jenni is a courageous and articulate advocate for all those who have struggled with eating disorders.

And she also happens to be a pretty rockin' songwriter, too! Her new single CD is called, what else, "Life Without Ed," and it's inspiring listening. Have a listen here. It's very cool.

Do your Monday morning best for mental health parity

This just in from the Eating Disorders Coalition:

"Thank you for all your unified effort in supporting the passage of mental health parity! We are close to victory in the House of Representatives— to pass H.R. 1424, the “Paul Wellstone Mental Health and Addiction Equity Act”. This bill would require health plans to cover eating disorders and has made it out of 2 committees and the subcommittee of Energy and Commerce. The last step in order for the bill to go to the floor for a vote is to get moved out of the Energy & Commerce Full Committee. That mark-up is scheduled for next Tuesday, October 16th. We need your action on this!

If your Representative is a member of that Committee, please call him/her on Monday morning to urge a “YES” vote on the bill, and a “NO” vote on all weakening amendments!"


And here's the list of representatives on that crucial committee. If yours is on there, please give him or her a call. The EDC has even written a suggested script for you to say when you do call: "“I’m calling to ask the Congressman/woman to VOTE FOR H.R. 1424 on Tuesday in the Energy & Commerce Committee, and to VOTE AGAINST all amendments to substitute weaker language. Americans deserve the same mental health parity protections that members of Congress enjoy, for all mental and addictive disorders, not just the ones health plans choose to cover.”

Go forth and help make policy. And parity.



FULL COMMITTEE

John D. Dingell (MI), Chairman

Ratio: 31-26
Henry A. Waxman, CA Joe Barton, TX, Ranking Member
Edward J. Markey, MA Ralph M. Hall, TX
Rick Boucher, VA J. Dennis Hastert, IL
Edolphus Towns, NY Fred Upton, MI
Frank Pallone, Jr., NJ Cliff Stearns, FL
Bart Gordon, TN Nathan Deal, GA
Bobby L. Rush, IL Ed Whitfield, KY
Anna G. Eshoo, CA Barbara Cubin, WY
Bart Stupak, MI John Shimkus, IL
Eliot L. Engel, NY Heather Wilson, NM
Albert R. Wynn, MD John Shadegg, AZ
Gene Green, TX Charles W. "Chip" Pickering, MS
Diana DeGette, CO, Vice Chair Vito Fossella, NY
Lois Capps, CA Steve Buyer, IN
Mike Doyle, PA George Radanovich, CA
Jane Harman, CA Joseph R. Pitts, PA
Tom Allen, ME Mary Bono, CA
Jan Schakowsky, IL Greg Walden, OR
Hilda L. Solis, CA Lee Terry, NE
Charles A. Gonzalez, TX Mike Ferguson, NJ
Jay Inslee, WA Mike Rogers, MI
Tammy Baldwin, WI Sue Myrick, NC
Mike Ross, AR John Sullivan, OK
Darlene Hooley, OR Tim Murphy, PA
Anthony D. Weiner, NY Michael C. Burgess, TX
Jim Matheson, UT Marsha Blackburn, TN
G. K. Butterfield, NC
Charlie Melancon, LA
John Barrow, GA
Baron P. Hill, IN

See a video on Maudsley

Here at NBC Chicago. Try not to pay attention to the misleading title, and you will have to watch a short ad before the video loads, and of course there are the usual caveats at the end of the piece. But it seems like a good look at an ordinary family who are helping their daughter through family-based treatment Features Dan Le Grange. I think it's worth a watch.

I just don't get it

It is just shocking to me that so many people misperceive and fear family-based treatment.

I'm no dummy: I know even FBT is no panacea. It won't cure everyone. But it cures a damn sight more folks than anything else we've got. And a lot quicker, too.

So what's the problem? We don't advise against penicillin because some people are allergic to it, do we? We don't dismiss Prozac because hey, it doesn't work for everyone.

So why are people so dismissive of Maudsley? I'm talking about people who haven't worked with it, who are going only by what others say about it.

Maybe it's like a generic medication--there's no big money to be made on it, so there's no incentive to fall in love with it.

But as Daniel Le Grange said to me recently, "We're not doing very well by our children." FBT helps children and adolescents, no question about it. The statistics are very good--80 to 90 percent of those treated with it are still recovered after five years.

FBT doesn't get into cause. It doesn't have an opinion, so to speak, on psychodynamic issues. It rather neatly sidesteps them, at least for phase 1 of treatment--weight restoration.

Is there anyone out there who can truly argue with the need for someone who is severely malnourished to gain weight?

I just don't get it.

6 lessons I learned at NEDA

1. There are lots and lots of well-meaning but ineffectual folks working in the eating disorders field.
2. There is lots and lots of Big Money at stake in the eating disorders field, mostly in the form of residential treatment centers.
3. There are lots and lots of politics in the eating disorders field.
4. Family-based treatment, which the scientific literature recognizes right now as the only evidence-based treatment with an 80 to 90 percent long-term success rate in adolescents, is perceived as controversial in the eating disorders field, even by some of those who profess to support and use it.
5. The most commonly heard comment about FBT at the conference: "Don't you have to be a very special family to make it work?"
6. The intensive outpatient family therapy for eating disorders program at University of California-San Diego, headed by Dr. Walter Kaye, looks absolutely wonderful.

I'm sure there are more, and I'm sure I'll be posting about them too.

Sunday morning at NEDA

The NEDA conference is officially over, but I've still got a bag full of brochures and other stuff I collected here (and I'm not going home until tomorrow morning), so I thought I'd offer another deconstruction of e.d. programs and what they offer to parents.

The reason I'm doing this, by the way, is not just to make enemies (though I'm sure I am) but to try to offer one parent's view of what's on offer. I think it's especially important given a snippet of conversation I had yesterday with one of the long-time NEDA folks, whose comment about Maudsley was, "But you have to be a very, very special family to make that work, don't you?" This is, of course, the mainstream view, and of course it's completely erroneous. It's part of the disempowerment of parents within the eating disorders field that just burns my boat.

So. Within that context, it's not surprising to find brochures like the one I picked up from the Women's Center at Pine Grove, in Hattiesburg, Mississippi, a treatment facility that treats e.d.s, addictions, and both. Here are some of the phrases that jumped out at me from this 12-page glossy brochure: "Components of the treatment experience include understanding the disease process and the camouflaged self, helping women reclaim and celebrate their feminine spirit, empowering women to come to their own assistance. . . . " There's a family week--sounds good, right?--described as "40 hours of intensive therapy where the healing process between family members begins." OK, this center is for women strugglng with addiction as well as e.d.s, and does not seem geared toward adolescents. There are photos of lovely flower arrangements and wooden staircases. Under Amenities, the brochure says, "We offer gender-responsive treatment in a quiet, peaceful, and secluded environment." I'm not sure what gender-responsive treatment means. The next paragraph goes on: "We encourage our patients to take advantage of the nearby YMCA . . . a facility that includes weights, cardiovascular equipment, indoor track and pool, indoor racquetball and basketball course."

Hello? For women in the throes of anorexia?

Nowhere in this brochure is there any mention of food or eating. Nowhere. There is one line under "Components of Treatment" that says "Nutritional counseling." It's about halfway down a list that includes items like "Boundaries & Relationships," "Exercise & Fitness," and "Psychodrama."

I don't think so.

Saturday morning at NEDA

This morning's program featured two parents and a husband, all of whom had family members who had anorexia, all of whom had the same therapist. I have tremendous respect for all three of these people, who obviously went through tremendous suffering. I'm happy to say that all three of their family members recovered and are now doing well--but only after many years of being ill. One spouse was ill for 10 years; one of the children was sick for 6 or 7 years, and the other for 10 years.

One of the parents made a comment that for me crystallized everything that's wrong with the way eating disorders have been traditionally treated. He said, speaking of his then-11-year-old daughter, "My wife and I quickly had to accept the fact that this thing was bigger than we were, bigger than our family. There was no way we could help her. We had to turn to the professionals."

His child's recovery followed a fairly typical trajectory: years of very slow progress and relapse, until, as he put it, "She *decided to join us in the fight against her illness."

I got tears in my eyes at that moment, tears of rage for the clinicians who disempowered this family and made them believe there was *no way* they could help their daughter, who taught them that their daughter had to "choose" to get well. For all the families who have accepted that over the years, who have sat at dinner tables watching their children starve and felt there was nothing they could do. Who, frankly, wasted years of their own and their child's life in useless and even counterproductive treatment.

I am so grateful for family-based treatment, for having my role as a parent validated and for being able to help my daughter. Another of the parents said, "I wanted to just march in there and get this thing fixed! But we had to embrace the illness and accept that it would be with us for a long, long time."

If only she'd been told about FBT, how might her life and the life of her daughter have been different?

If only they knew . . .

Over the last two days I've collected quite a bit of material from the many residential treatment centers that are exhibiting here at NEDA. I'm going to be writing about a few of them, starting with the brochure from Rogers Memorial Hospital in Oconomowoc.

If only the people who'd put this slick piece of marketing together knew how parents really reacted to it--or should. I already have an opinion about the programs at Rogers, but if I didn't, this would certainly sway me.

For starters, the image on the cover is of a girl. A young woman, really, maybe 14 or 15 years old. She's smiling, she's very pretty--and she's excruciatingly thin. It's hard to tell just how thin because she's wearing a hoodie over a shirt. But she's a lot thinner than I'd want any child of mine to be. Is she supposed to be recovered? In recovery? Newly arrived at Rogers? If this is a picture of the Rogers recovery, I'd run in the opposite direction. Fast.

Then there are the words that go with this image: "At Rogers Memorial, we utilize proven, evidence-based treatment components that give individuals with an eating disorder the best chance at recovery."

So far, so good. But there's more: "Our philosophy encourages self-empowerment, so that the individual's recoveryt is a result of his or her own success."

Uh-oh. If I'm a new parent I might think this sounds good. But everyone else will read this and know what it refers to: the tired, disproven notion that the individual must "choose" recovery.

Next come some quotes, presumably from Rogers patients, though they're not identified. Top of the list: "The treatment and therapies helped me realize it was my choice to get better." I say stop reading right there and throw the darn thing away. But if you insist on continuing, you'll find this one: "The art therapy was extremely helpful and provided another way for me to explore my eating disorder."

Explore your eating disorder? Honey, I don't want you to explore your eating disorder. I want you to RECOVER from it. Big difference. In fact we may be talking an oxymoron here.

Seen enough? No? Then turn the page for more on the Rogers approach: "Our treatment approach encourages self-empowerment. From admission to discharge and aftercare planning, individuals are involved in every step of the treatment process."

As the parent of a child who's recovered from an e.d., I can't think of anything worse than to have my child involved at every step of the way. As those of us who have been through this know, a child is INCAPABLE of "choosing" recovery, and when she's very very ill, such insistence will a) prolong the course of the disease, b) make treatment ineffective, c) exacerbate the child's already sky-high anxiety, and d) make veryone involved feel guilty as hell for not being able to "choose" recovery.

And here's the thing that gets me: This brochure is supposed to be marketing the program, making it sound irresistible to parents.

I'd say the Rogers folks haven't got a clue about what at least some parents want. And judging from this brochure, I'd say my confidence in their ability to help my child recover is pretty minimal.

That's it for tonight. I'll pick apart some more tomorrow.

More from NEDA

One of the heartening things about the conference so far has been that the amount and kind of discussion around family-based (Maudsley) treatment for anorexia and bulimia. There's been a lot! And all of it's been positive, at least that I've heard. In fact I would say that Maudsley has become something of a buzzword. Some of the people using it seem to have only a hazy idea of what it means, but I guess that's part of the process of this kind of social change.

The general session speakers have been a real mixed bag. This morning's speaker spent more time telling anecdotes about her cats, her children, and herself than anything else, and when she did finally get down to brass tacks, she mostly talked about body image. I'm all for discussions of body image, and how to improve it, but what got to me was her automatic assumptions that disturbances of body image = eating disorders. There was a lot of talk about things like guided visualizations, talking "to" problem body parts, and so on, none of which interests me but hey, I can see that it might be of interest to some people.

The thing that got me, though, was when she tried to connect these kinds of problems and solutions to anorexia. I asked her, if body image disturbance causes e.d.s, why don't we have way more prevalence of anorexia and bulimia? She had no answer. Later, someone else suggested to me that while AN and BN are relatively low incidence, there are a lot of eating disorder not specified cases that don't show up in the statistics. Maybe. What bugs me is the thought of people with anorexia and bulimia who are valiantly trying to recover through these kinds of treatment techniques. There is no evidence to suggest that they're effective. Common sense, and having gone through anorexia with my daughter, tells me they can be worse than useless--they can destructive because they take focus off the things that really matter, like refeeding. So I'm not thrilled with what I heard there.

This afternoon's speaker, Michael Strober, did a very good job of discussion some of the neurobiology of comorbidities. He made one interesting point (well, he made more, but this one was of most interest to me): he said that while most depression that you see in patients with anorexia comes as a result of the starvation, and shows up after and as a byproduct of malnutrition, the heightened anxiety you see almost always precedes the dieting and weight loss behaviors. This was certainly the case in our family: my first inkling that anything was wrong with my daughter was her anxiety level skyrocketed, and she'd never been an anxious kid. No one understands the mechanism, but it was a very interesting observation.

That's it for now--gotta go get in the hot tub! (LOL)

More from San Diego later.

San Diego dispatch

Here I am in beautiful San Diego at the NEDA conference. It's my first time at something like this and I'm not sure what to expect. So far . . . well, it's a mixed bag.

Yesterday afternoon I was lucky enough to have lunch on the UC-San Diego campus with Dr. Walter Kaye and his talented team. Their 5-day Intensive family outpatient program for treating anorexia and bulimia sounds fab to me. (Check it out at http://eatingdisorders.ucsd.edu/IFT.html.) If the program had been around when my daughter was diagnosed with anorexia, I think we would have been here in a heartbeat. And I think it would have been a life saver. Literally.

Back at NEDA, pretty much the first thing I did was wander the hall of goodies, where the folks who treat e.d.s set up booths and put out their marketing info. It was all very slick and very disheartening. I walked around asking people what their treatment philosophy was. Half of them didn't understand the question. Many reassured me that they had "all kinds of treatments." Horses seemed to figure prominently, at least in the literature, along with "groups getting at the psychosocial dynamics of anorexia" and so on. When I asked what kind of evidence-based treatments they offered, most looked blank. When I asked how or whether they included families in treatment, a few sounded intelligent, but most, once more, looked blank.

Then again, we're dealing with an area where the American Psychological Association itself still lists
"dysfunctional families or relationships" as one cause of anorexia, and describes the anorexics as "refusing to eat." Tsk tsk, APA; you're sadly out of date. If you knew one thing about anorexia you would know that it's not a refusal to eat; it's an inability to. And you'd also know that PARENTS DO NOT CAUSE EATING DISORDERS. (Read the APA's ill-informed e.d. page at http://www.apahelpcenter.org/articles/article.php?id=9.)

The worst of the hall were the booths sponsoed by the big guns in e.d. treatment: Renfrew, Rader, Remuda. There were lots of slick little products to take home, ranging from staplers to, I kid you not, Zen sand gardens. What does all this have to do with treatment? You have to be cynical here and remember that there's very big money attached to the treatment of e.d.s. I would have far preferred an outcome study for parents to take away over a cutesy little mirror with an affirmation on the back. Please.

The keynote speech last night started out well, with a report from Lynn Grefe, the president of NEDA. Next up was a young editor from CosmoGirl whose main purpose seemed to be to convince us of how well-meaning that magazine is about presenting positive body images to young women. It sounded like one big advertisement for CosmoGirl. Somewhere in there she referred earnestly to an article they'd run called "Fat and Thin," and flashed a visual from the magazine on the screen. There it was: a headless fattie, next to a headless waif, followed by more earnest talk about how obesity is an eating disorder, too.

I wanted to stand up and say, "That's like saying thinness is an eating disorder, honey. It's not how much you weigh; it's your relationship with food and eating." But it is, after all, my first NEDA conference, and I was feeling a little shy.

Next time.

More from NEDA later today.

Are you going to NEDA?

To the annual National Eating Disorders Association conference in San Diego, that is. If so, please look me up and say hello. I'll be presenting on Friday afternoon, along with Dr. Walter Kaye and Laura Collins, author of Eating With Your Anorexic. Stellar company and what promises to be a much-needed panel discussion on families and eating disorders treatment.

Finally, we're talking about eating (rather than weight)

Amid the usual hysterical news stories about the so-called obesity epidemic I was pleased to come across an item about new research out of Penn State looking at eating competence as a risk factor in heart disease.

Using an eating competence scale developed by Ellyn Satter, researchers found that--surprise, surprise--people at risk for heart disease fared better when they were "confident, comfortable, and flexible with their eating habits."

Being comfortable with your eating seems to mitigate other risk factors, including elevated LDL cholesterol. It's process over product, holistic health over health-by-the-numbers. It's the act of eating rather than the rigidly controlled carbs and calories approach.

Now we know the truth: fear of food is bad for your health. Mangia va bene!

Eating Disorders Coalition action alert

Anyone who's ever tried to get a mental health issue covered by insurance (or, as they're called in our state, "behavioral health issues") will want to act on the EDC's latest action alert:

"You can help Pass the Paul Wellstone Mental Health and Addiction Equity Act (H.R. 1424) today by calling House Speaker Nancy Pelosi toll-free at 877.978.9996 and telling her that you support the passage of this mental health parity act."

The sound of one shoe dropping

The other shoe, that is. It's been a hell of a few years in our household, between medical traumas of various kinds, including Kitty's anorexia, my mother-in-law's lingering illness and death, and now the legal machinations of her despicable and greedy second husband. (Who knew people could be such asshats?)

So now I'm down with some health problems of my own, hopefully not for too long and nothing permanent, but very unpleasant in the short term.

So forgive me if I don't do too much posting for a little while. Carry on.

Today's post is a poem

It's true: I cop to being a poet first and foremost.

SEPTEMBER 11, 2001: POEM FOR MY LATE FORTIES

See, one day I realized I was thinking about death
as if it were a problem I could solve, as if
through sheer brilliance, hard work, or luck
I could outwit my fate, land safe on solid ground.
So all of this, I mused—-the sweet blue sky,
the falling light, the dizzy bone-deep fix
of oxygen and sun and fire—-was plain
out of my hands. I was free, it seemed,

to keep on stumbling—-blind, confused,
ticked off—-up the old twisting path,
to reach the top at last and claim
my prize: to face the dark wood,
as the poet said, and, pissing
in my pants with fear, go on.

To be published in Oberon later this year

Entering the dieting/FA fray

I'm going to tell you a story: I once had a friend named Mimi Orner who was a fat activist, woman of size, brilliant teacher, and all-around wonderful person. Here in Madison, Wis., where I live, she started a group that was anti-anorexia, anti-bulimia, and anti-dieting. This was about 15 years ago, mind, somewhat ahead of her time.

Mimi died seven years ago from ovarian cancer. Her appetite for food, like her appetite for life, lasted until pretty close to the very end. Her memorial service was attended by hundreds of people, many of whom got up to speak. All of these tributes were very moving, but the one I remember was a young woman who stood up, tears pouring down her face, and confessed that she and Mimi had once been close but of late had been a little bit estranged. "I found her so inspiring," she said through tears, "and I want to believe what she ways [about fat acceptance]. I'm not as smart or as good as Mimi. I just can't accept myself as a fat person, at least not yet. So we grew apart. And I've missed her so much. And now I'll never have the chance to make it right."

This young woman's words have stayed with me because they capture so vividly the dilemma of the individual and the political. Sometimes, you know, the emotions take a while to catch up with the intellect. Sometimes they never do. That's part of being human. We can't legislate our feelings.

Much as we might like to sometimes.

I miss Mimi too. I wished she was there two years ago when my daughter got sick. I wished she was there when I gained 50 pounds from a medication and struggled with that. I wish she were here now, so we could debate and argue and disagree and learn from each other.

Ass-backward science

I used to think the Brits were far more evolved than we Yanks. But that was before Marcella sent me this unbelievable bit of rationalizing from the U.K Food Standards Agency.

According to guidelines passed by the FSA, cheese, honey, marmite (that's how you know you're in the UK), and breast milk* are unhealthy and therefore banned as the subjects of food advertising to kids.

On the other hand, chicken nuggets, microwaveable curries, oven chips (I assume this is french fries), and diet sodas are A-OK, according to these standards.

This is what I think of as ass-backward science: First you decide what result you want your data to show. Then you screw with said data until it shows it.

So the makers of chicken nuggets can happily continue to flog their stuff to the kiddies**, but the beekeepers and cheese makers are SOL.

Nice going, guys.



* Breast milk's fat content would render it unhealthy by the FSA's standards.

** I lived in London for a year and I speak Brit too!

A basic misunderstanding of anorexia

has got to be part of where nutrition "expert" Dr. Elliott Berry is coming from when he offered the latest in potential anorexia treatment: cannabis.

You can't blame Dr. Berry; anyone who reads DSM-IV gets the same wrong-headed criteria for anorexia front and center: Anorexia is a "refusal t maintain body weight at or above a minimally normal weight for age and height."

It's the word refusal that is so misleading. Those of us with personal knowledge understand that it should read inability to maintain body weight. Someone with anorexia isn't "refusing" to eat, because s/he's not really capable of making a choice on the subject of food and eating.

I'd love to see this definition change, and with it our notions of good treatment. I'd love to see a time when starvation would not be an option, when we didn't confuse appetite with illness. And I don't think cannabis has any place in the treatment of anorexia.

What obesity is

At least according to endocrinologist Robert Lustig: “Obesity is not a disease or a behavior. It’s a phenotype (a trait or characteristic in a subset of the population), which is a manifestation of many things.”

Lustig was talking about why there will never be a "one-size-fits-all" weight-loss drug.

Now if only he'd gone a step further, and questioned the need for a pill to change a phenotype.

Why intuitive eating works

This just in from an article published in today's edition of the Journal of Physiology: ". . . during a reduction in energy stores or circulating nutrients, the brain initiates responses to restore and maintain energy and glucose homeostasis. In contrast, in times of nutrient abundance and excess energy storage, the brain promotes reduced food intake and increased energy expenditure."

In other words, deprivation makes your brain and body store fat. But having access to plenty of food can lead to eating less and moving around more.

This has always been my experience. When I give myself permission to eat what I'm truly hungry for--and stop eating when I'm satisfied--I eat less than when I go into deprivation mode.

It's interesting to know that there's neurobiology at work. The human body is a wonderful thing.

F as in Fat, K as in Knee-Jerk

On our last morning in Utah I picked up a copy of the Salt Lake City Tribne and was appalled (but not shocked, alas) to read an editorial based on the Robert Wood Johnson Foundation report mentioned a few days ago. Its concluding paragraph:

If you're "F" as in fat, you'll be "D" as in dead.


Talk about scare tactics. . . .

I haven't done a search, but I wonder how many other newspapers picked this up and ran with it.

The good doctor

After reading fillyjonk's recent post over at Shapely Prose, and all the comments that followed, I realized it's time to say thanks to my wonderful internist.

So here's to you, Dr. Nancy Fuller, for being the kind of doctor who has never slapped the scarlet O on me. To you I am a patient, not an unacceptable number on the scale. I've brought all kinds of health issues to your office, from panic disorder to hot flashes to headaches, and never once have you said or implied that it's All Because I Need to Lose Some Weight.

Thank goodness you are not Dr. Sanjay Gupta, who writes in Time magazine, "Obesity, of course, means a higher risk of heart disease, diabetes, hospitalization and early death, so how come doctors are so lax about putting the scarlet O on the chart?"

How come indeed, Dr. Gupta?

Could it be that some doctors look beyond the numbers on the scale to a patient's true health? That they know all too well that putting a patient on a a diet through scare tactics will almost always backfire, winding up with the patient heavier than they already are? That shame is not a good motivator, and neither is fear?

Could it be that some doctors are not as egotistical as you, who seem to to believe that those who are fat don't really know it until it's pointed out by a doctor?

Could it be that some doctors have gone a little deeper into the subject, and know that fat does not always (or even usually) equal bad health? That fat can be fit and healthy, and thin can be unhealthy?

I far prefer my good doctor's approach. She takes time to talk with me, listen to me, guide me toward healthy choices in all ways. When I walk in the door she sees me, not just my measurements. And so I trust her.

And that's the basis of a healthy doctor-patient relationship.

Another missed opportunity

The Robert Wood Johnson Foundation has just come out with a report, "F as in Fat: How Obesity Policies Are Failing in America in 2007," in which it makes the same tired (and superficial) observations and beats the same dead horse some more. According to the report:

* Adult obesity rates rose in 31 states last year.
* Twenty-two states experienced an increase for the second year in a row; no states decreased.
* A new public opinion survey featured in the report finds 85 percent of Americans believe that obesity is an epidemic.

This last one made me laugh out loud. And this proves what, exactly? That most Americans will believe anything the media spoon-feeds them? Deep into George W. Bush's second term, we already knew that. But I digress.

* Rates of adult obesity now exceed 25 percent in 19 states, an increase from 14 states last year and 9 in 2005. In 1991, none of the states exceeded 20 percent.

Of course the report fails to mention the change in the BMI chart that created millions of new overweight and obese people overnight. Oops--I digress again.

* "There has been a breakthrough in terms of drawing attention to the obesity epidemic. Now, we need a breakthrough in terms of policies and results," said Jeff Levi, Ph.D., executive director of Trust for America's Health.

You got that right! You'd think that maybe this would be the moment to stop, take stock, and say, Wait a minute, maybe we're fucking up here. Could it be that we're actually making things worse by flailing around? But no. Levi went on to say, "Poor nutrition and physical inactivity are robbing America of our health and productivity."

Give me a break. He's just parroting the conventional lack of wisdom that says all fat people are couch potatoes eating junk food and watching TV.

The press release goes on to tout other "key findings":

* Twenty-two percent of American adults report that they do not engage in any physical activity.

But there's no context for this. Has this changed? I think people are more physically active now than they were 20 or 30 years ago. When my grandmother and mother were my age, they weren't out hiking the Utah mountains or dancing all night. They didn't go to the gym, jog, or play softball. And yet we're the ones who have the "obesity epidemic."

Once more, an opportunity for reflection and going beyond the conventional wisdom--sadly missed.

But the report does more than list problems. It proposed solutions. Solutions like this one, which tops the list:
* The federal government should develop and implement a National Strategy to Combat Obesity. This plan should involve every federal government agency, define clear roles and responsibilities for states and localities, and engage private industry and community groups.

I don't know whether to fall on the floor laughing or be truly frightened. And what about this:

* Federal, state, and local governments should work with private employers and insurers to ensure that every working American has access to a workplace wellness program.

I don't want a workplace wellness program, because what I know about them is that they're as much a joke as school wellness curricula. They exist to penalize workers who don't measure up to the approved guidelines, through surtaxes for those who are overweight, for instance. Unless they're paying for health club memberships for employees, and giving them an hour and a half lunch to go work out, I don't want to hear about it.

If RWJF has its way, our already eating-disordered culture would go beserk. Talk about obsession--they want to get the whole freaking government involved.

What a nightmare.

**Read the press release yourself at www.rwjf.org/newsroom/newsreleasesdetail.jsp?id=10512, which also has a link to the full tet of the report. Sorry I can't link it--still remote blogging.

Fat as metaphor

Meowser's comment on an earlier post got me thinking. She wrote:
"Whenever I see/hear anyone complaining about fat people walking around, or at the gym (where we're just piddling around and slowing things down for the buff crowd, you see, no fat person could possibly be getting an actual workout there), or dancing, or riding around on bikes, it totally gives the lie to the "unhealthy! unhealthy! diabetes! diabetes!" meme. Because people like that would totally rather we stay home and stuff our fat faces where they can't see us, rather than actually move around. I believe my mother cares about my health. I don't think some random stranger who doesn't know me really gives a damn if I'm "healthy" or not, and in fact, it would really piss them off no end if I had numbers proving that, apart from my weight, there is nothing wrong with me.'

I've been thinking as fat-as-a-symbol, the way it's most often used: as a metaphor for imperialism, greed, overconsumption, etc. Meowser's comment makes me wonder if it's also used as a symbol for questioning authority. Do fat people stick in the craw of the entitled thin establishment because we're not following the rules? Because we aren't doing whatever it takes to get thin, and stay thin? Do we piss them off because we're perceived as thumbing our noses at the authority figures?

I find it interesting that in a time of such extreme individualism, this is one area where being quirky, or not fitting the mold, is perceived as being unacceptable. We've become such a tolerant society in so many other ways. Though I know we have a long way to go on racism, still we've come a long way. When I was in college I was at the center of a near race riot, caused in part by my dating a black man and by the reactions of both whites and blacks on campus. That wouldn't happen today, not even in the deep south. The kind of anti-Semitism I bumped into as a child wouldn't be tolerated today, either.

So what is it about fat that gets people so riled up? Maybe fat people challenge, by our very existence, the marketing economy we can't escape. We're not buying into the pills, creams, products, etc. that are supposed to make us thin. (Though God knows many of us *have* bought those things, in the millions.) Maybe it's that fat people are perceived as not buying into the marketing imperatives about aesthetics, which are used to sell everything to everyone, from cars to cereal. We're not good consumers in the broadest sense of the word.

I wonder.

And what's the point, anyway?

This whole you-can't-be-fat-and-fit, fat-is-always-unhealthy thing is really bugging me. Because really, what's the point?

The debate is beginning to remind me of my second-grade friend Linda Read, who had just learned in catechism that people like me--i.e., Jews--were going to burn in hell forever. And because she was my friend, she tried to convert me, of course, to spare me the suffering she knew was coming my way someday and forever.

Now let's say that guys like Walter Willett and Paul Raeburn (see previous post) are like my friend Linda. They really really believe that people like me--i.e., fat people--are going to health hell. Either we're going to get terrible diseases or we're just going to keel over at a tender age. (I once listened in astonishment to a neighbor talking about a certain fat actress on TV: "I can't even stand to watch her because I just know she's going to drop dead at any second!") So they set out to convert us.

But they know that it's not that simple. They know, for instance, that for most people dieting does not work, for a variety of reasons. Now here's where I really don't get it. Because you'd think the next tactic would be to encourage positive behaviors like fitness. Some fat people will lose weight that way; some won't. But we do know that being fit is a good thing no matter what your weight.

So why, then, do we get drivel like Raeburn's piece in Scientific American on how you can't be fat and fit?

Is the point to to shame us out of getting out there on our bikes and exercising? (I thought the photo at the front of that piece was exploitative.) Is the point to make us throw up our hands and say, "Well, no reason to bother exercising, since the only thing that counts is losing weight."

It feels so disingenuous. It feels like the point, such as it is, is fat bashing. So what if you're a triathlete--if you weigh 300 pounds then you can't possibly be healthy, so don't even bother.

And this bothers me far more than the other kind of health crusaders, the ones who are really like my friend Linda Read. Who worry for our fat souls, as it were, and want to save us.

These guys just want us to go to health hell already. And that makes me mad.

Because he said so, dammit

This article by Paul Raeburn in the September issue of Scientific American, starts out well but quickly goes belly-up. So to speak. Raeburn's burning question--"Can fat be fit?"--is presented as genuine, but it's clear from the second graf that he's got an agenda rather than a genuine curiosity about the question.

He pays lip service to Katherine Flegal's research showing that being overweight (BMI between 25 and 30) may actually lower your risk of mortality. Flegal's drawn a lotta flak since her study came out, of course, and no doubt there's more to understand. But Raeburn doesn't try too hard. He sets Flegal up as a straw man and knocks her down fast with other research that seems less than compelling. He quotes Walter Willett of the Harvard School of Public Health, and writes, "Willett’s research has identified profound advantages to keeping weight down—even below the so-called healthy levels."

Here we have it once more, ladies and gentlemen, the mantra of so much that's being written these days about fat and thin. Flegal's research doesn't count because, as we all know, the lower your weight the better.

I can hear Willett saying, "Fat is too bad for you! [foot stomp] Why? Because I said so!"

I don't know Paul Raeburn's writing, but I do expect better than this paltry effort from Scientific American.

Sandy Szwarc is my hero

If you'd like to know why, see her blog post today on disease vectors at http://junkfoodscience.blogspot.com/2007/08/disease-vectors.html.

Finally, someone with some common sense about fat

And that would be a research team from Penn State University, warning that parents should not deprive their children of fat, despite all the hysteria about obesity.

"The authors said, 'Sufficient fat must be included in the diet for children to support normal growth and development.'

The authors said dietary fat recommendations are higher for children aged four to 18 (25 to 35% of energy) compared with adults (20 to 35% of energy)."

Gee, I could have told you that.

Interestingly, the only news articles I could find on this were published across the pond, in the UK. Hmm. Could there be a reason why this isn't being plastered across CNN?

Read all about it yourself at http://www.inthenews.co.uk/thebigissue/news/health/psu-researcher-sufficient-fat-needed-$1123529$1123528.htm. (Sorry, this remote blogging thing doesn't let me post links. Bummer. Anyone out there know how to fix it?)

Interesting new report on anorexia

In the August 7 issue of the International Journal of Eating Disorders, researchers at Rouen University Hospital in France describe a woman with anorexia who was found to have a brain lesion. When the lesion was treated, the anorexia went away, supporting the notion that AN is indeed a disorder with strong roots in the physical brain.

I'm blogging remotely today, so I can't post a direct link, but you can see the study abstract at http://www.ncbi.nlm.nih.gov/sites/entrez?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=17683096&itool=pubmed_DocSum.

Not for the humor impaired . . .

. . . but very, very funny is this spoof from the folks who bring you The Onion. (Bragging moment: My neighbor's son is the managing editor of The Onion. Go Pete!)



*Thanks, Kay, for the link!

And now for something beautiful

My amazing husband, Jamie Young, has a simply gorgeous photo featured on this website. It's called "In a Dream" and was taken at Chimney Bluffs State Park in New York.

You gotta love a guy who can do this.

Not just docked but dumped

As a follow-up to my earlier post about being docked for being overweight, now it turns out you can be turned down for health insurance altogether, as reported in this article from the weekly alternative newspaper in my town. And wouldn't ya know it--my new employer's health insurer is Humana. (And so far they, um, are living up to their reputation.)

Please tell me this isn't happening . . .

At least one health insurer (and probably others) will actually be docking your paycheck if your BMI is over 30, starting in 2009.

The article's headline reads "Being Unhealthy Could Cost You--Money," but of course it should have read "Being Fat Can Cost You--Money." And that's on top of it costing you so many other things--the right to adopt a child, a seat on an airplane, a job. . . .

I wish I were a lawyer so I could start researching all the ways in which this is illegal. A nice big lawsuit--maybe a class action suit--might nip this repulsive idea in the bud.




**Thanks to BFB for posting on this first.

And another Leaden Fork award goes to . . .

Apple, for the revolting tagline promoting the new iMac:

You can't be too thin. Or too powerful.

News flash to Steve Jobs and his marketing department: You sure as hell can be too thin. Your hair can fall out. You can be cold all the time. Your heart can slow down. You can become psychotic on the subject of food. In fact, you can be possessed by an illness so powerful that it actually causes you to violate the most basic human instinct: self-preservation. You can be so thin that you actually commit suicide by starving yourself, while in the grip of a delusion so powerful that neither reason nor logic nor love and empathy from others can touch it.

If you want to step inside the mind of someone who is too thin, read this. I hope you weep.


**Thanks to Cynthia for the link.

Leptin babies, redux

Now the New York Times has taken up the idea of lacing baby formula with leptin to create children who are permanently unable to become fat.

I posted about this back in May, when the research on this first appeared. And I haven't changed my mind. Haven't we done enough damage by our relentless pursuit of thinness? Do we really think creating a generation of children whose bodies are permanently and deliberately made inefficient is a step forward? What if those children should find themselves in a situation where they need some nutritional reserves? What if they develop anorexia? Imagine the hell of trying to re-feed a child who is physically unable to gain weight. And what about when those children grow old, at a time in life when being "overweight" is correlated with having the lowest mortality risks? Maybe thin won't look so hot when it's a life--or death--sentence.

Maybe someday we'll stop confusing aesthetics with health. Yeah, right. And maybe someday I'll be president of the United States.

Another step toward mental health parity

From an e-alert sent out by the Eating Disorders Coalition (EDC):

Senate Agrees to Remove Barriers to Mental Health Coverage
Republican senators this morning removed language from the Senate's parity bill that would have made it more difficult for people with eating disorders to get treatment under many health insurance plans. The senators heard from business leaders and insurance companies, who last night decided to strike the preemption section of the Mental Health Parity Act of 2007 (S 558). Mental health advocates believed that the preemption clause would weaken the parity bill, leaving it up to state laws to determine whether eating disordhttp://www.blogger.com/img/gl.link.gifers would be covered.

"This is a huge step forward," said EDC President Kitty Westin. "It shows that our work is paying off. It appears that the Senate will vote on parity this afternoon before the summer recess begins. If that happens, then mental health parity will probably be on top of the House agenda in early September, when Congress returns."

The EDC has actively supported the House and Senate bills.


What happens next?

The Energy and Commerce Committee of the House of Representatives will probably vote in early September on the House parity bill, the Paul Wellstone Mental Health Equitable Treatment Act of 2007 (HR 1424).

What can you do?

If you are represented by a member who serves on this committee, call, write, or visit the member in August and explain why you think mental health parity is needed. Most members are spending much of August in their home districts, close to where you work or live.

HOUSE ENERGY & COMMERCE COMMITTEE

John D. Dingell (MI), Chairman

Democrats Republicans
Henry A. Waxman, CA Joe Barton, TX, Ranking Member
Edward J. Markey, MA Ralph M. Hall, TX
Rick Boucher, VA J. Dennis Hastert, IL
Edolphus Towns, NY Fred Upton, MI
Frank Pallone, Jr., NJ Cliff Stearns, FL
Bart Gordon, TN Nathan Deal, GA
Bobby L. Rush, IL Ed Whitfield, KY
Anna G. Eshoo, CA Barbara Cubin, WY
Bart Stupak, MI John Shimkus, IL
Eliot L. Engel, NY Heather Wilson, NM
Albert R. Wynn, MD John Shadegg, AZ
Gene Green, TX Charles W. "Chip" Pickering, MS
Diana DeGette, CO, Vice Chair Vito Fossella, NY
Lois Capps, CA Steve Buyer, IN
Mike Doyle, PA George Radanovich, CA
Jane Harman, CA Joseph R. Pitts, PA
Tom Allen, ME Mary Bono, CA
Jan Schakowsky, IL Greg Walden, OR
Hilda L. Solis, CA Lee Terry, NE
Charles A. Gonzalez, TX Mike Ferguson, NJ
Jay Inslee, WA Mike Rogers, MI
Tammy Baldwin, WI Sue Myrick, NC
Mike Ross, AR John Sullivan, OK
Darlene Hooley, OR Tim Murphy, PA
Anthony D. Weiner, NY Michael C. Burgess, TX
Jim Matheson, UT Marsha Blackburn, TN
G. K. Butterfield, NC
Charlie Melancon, LA
John Barrow, GA
Baron P. Hill, IN

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.