If I ruled the world . . .

No one, including me, would spend any of their precious time in the world thinking about whether they were fat or thin.

Food would just be food--sometimes sensual pleasure, sometimes just fuel for going on with.

Obesity would carry no moral disgrace. Thinness would carry no moral virtue.

No one would diet.

Because no one would diet, few people would develop anorexia.

Those who did show the first signs of anorexia would be treated promptly, effectively, and compassionately--with food. They would bounce back quickly.

Families would be supported in supporting their children, whatever their issues.

Of course there would be no war. There would be good schools for all children and good health care for everyone.

Everyone would learn to dance.

Art would be just as important as math in school curricula and in the world.

Now how about you?

If I had a (smaller) hammer . . .

To a hammer, everything looks like a nail. And the proverbial hammer we often talk about is the BMI, a simple height/weight ratio that's more and more being used to identify and punish everyone from schoolchildren to the lederly for being fat.

Of course, BMI is a crude tool, a hammer, if you will, because it doesn't take into account muscle mass, or percentage of body fat, or anything beyond height and weight. So most athletes fall into the overweight if not obese category, according to BMI charts. Tom Cruise's BMI makes him obese, because he's short and densely muscled.

Now, finally, someone somewhere is paying attention. In a study published in Nutrition Journal, researchers at the University of Pavia in Italy did a small study looking at how weight loss recommendations would change for a group of people when they applied different measures of overweight:

The researchers obtained each person's BMI as well as body-fat measurements including waist circumference and total percent body fat. The also calculated a measurement similar to BMI that identifies fat mass called body fat mass index. The investigators then compared the percentage of the study group that would be told to lose weight according to each calculation.

BMI calculations, they found, identified 11 percent of the group as needing strong recommendations to lose weight and 41 percent as needing basic recommendations to lose weight. By contrast, waist circumference measurements indicated about 25 percent would need strong recommendations to shed pounds and 36 percent would need basic weight loss recommendations, Colombo said.

Moreover, 29 percent and 48 percent would have received similar weight loss recommendations according to total percent body fat measurements, while 21 percent and 54 percent would receive the same, according to body fat mass index.

The lead researcher, Dr. Ottavio Columbo, concluded, "Using criteria based on body adiposity (fatness) rather than body weight would result in a much greater proportion of the study population receiving recommendations for weight loss."

Yeah. We coulda told you that. But hey, it's a start.

Under-reporting eating disorders?

This study, just out from Rhode Island Hospital and Brown University, is not only interesting, it's important. And timely. And has implications for the way eating disorders are both diagnosed and treated.

Researchers went back through data collected from some 2500 psychiatric patients and looked at the incidence rates of various diagnoses of eating disorders. They found--unsurprising to anyone familiar with eating disorders--that the vast majority of diagnoses were for ED-NOS, or "eating disorders not otherwise specified."

This is a catch-all diagnosis for those who don't meet the strict diagnostic criteria for anorexia or bulimia. The study authors intelligently suggest that the fact that ED-NOS is the most common e.d. diagnosis (at least in their sample)

suggests that there is a problem with the clinical applicability of the diagnostic criteria in the DSM-IV eating disorder category.

Yes! Too true. Why does it matter? Let me tell you a story.

When my daughter became ill, at age 14, our pediatrician diagnosed anorexia. It was clear to all of us that that's what she had. Her weight was down to 75% of what it was supposed to be; she was in ketosis, she was afraid of all food and drink, she'd withdrawn socially--in short, she had a classic case.

Following good medical procedure, the pediatrician referred my daughter to a psychiatrist. Our insurance would cover only a shrink-in-training, a very nice woman without a lot of experience. My daughter spent our first visit, and most subsequent visits, with her head in my lap, sobbing.

I'm not sure which of the diagnostic criteria for anorexia the psychiatrist felt my daughter did not meet:

DSM-IV Criteria for Anorexia Nervosa

1. Refusal to maintain body weight at or above a minimally normal weight for age and height (eg, weight loss leading to maintenance of body weight less than 85% of that expected or failure to make expected weight gain during period of growth, leading to body weight less than 85% of that expected).
2. Intense fear of gaining weight or becoming fat, even though underweight.
3. Disturbance in the way in which one's body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight.
4. In postmenarchal females, amenorrhea ie, the absence of at least three consecutive cycles. (A woman is considered to have amenorrhea if her periods occur only following hormone, eg, estrogen administration.)

My daughter definitely had #1 and #2 (though more on the wording of #1 in another post). She wasn't expressing #3, partly because by then she wasn't expressing much of anything, other than intense anxiety and fear. And she hadn't begun menstrual cycles yet, so #4 wasn't applicable.

In any case, the psychiatric fellow diagnosed her with ED-NOS--and you will be surprised to learn, as I was, that because they're classified as mental health disorders and appear in DSM-IV, only a psychiatrist can truly diagnose an eating disorder. The pediatrician's word counted for nothing.

The diagnosis informed our daughter's entire treatment with the psychiatrist, most of which consisted of useless attempts at anti depressants. The psych was convinced that if we treated the depression, my daughter's eating "issues" would magically improve or even resolve.

Why does it matter? Because we wasted a lot of time, and most of our precious mental health benefits, dicking around with this stuff. If the diagnosis had been anorexia, the psych could have looked up research showing that antidepressants are ineffective during acute malnutrition, and that depression is a symptom of anorexia, not a cause. She probably could have looked this stuff up anyway, but since she was never convinced my daughter had anorexia, I assume she just didn't go there. I don't know for sure what she was thinking, and it stopped mattering after a while.

Back to the study, which hypothesizes that many of the ED-NOS diagnoses are true cases of anorexia or bulimia that for one reason or another don't meet 100% of the clinical criteria. And that psychiatrists should take another look at the criteria and the cases.

I agree. And there's another implication, too: I'm convinced that the low incidence rates are one reason so few research dollars have been spent on anorexia and bulimia. Where are you going to spend your money, on a disease that affects 2 percent of the population or on one that affects 30 percent?*

So three cheers for the Rhode Island researchers, whose work, if somewhat obvious, is long overdue. I look forward to seeing how it might begin to change the clinical picture in eating disorders.



*I refer, somewhat sarcastically, to the proposal that obesity be classified as a psychiatric illness in DSM-V.

It is too genetic

Check out this new study, just published in the American Journal of Clinical Nutrition, in which British researchers looked at more than 5,000 pairs of identical twins and determined that

genes account for about three-quarters of the differences in a child's waistline and weight.

Here's the quote of the day:

"Contrary to the widespread assumption that family environment is the key factor in determining weight gain, we found this was not the case," said Jane Wardle, director of Cancer Research UK's Health Behavior Centre, who led the study.

So what does this mean? It means that maybe we can stop obsessing over children's BMI and focus instead on their OH--their overall health. It means that families can go back to making sure their children are healthy without all the woohoohoo about them being fat. Most important, it means that maybe, just maybe, we can start ditching some of the blame and shame about fat and pay attention to what really matters.

As the Dressing Room Project folks like to say, Worry about the size of your heart, not the size of your body. Amen, sisters.

Here's a PDF of the entire study. Have fun with it.

News flash: Oprah's gaining weight

Though I despise the culture of celebrity obsession, I found this story from the Orlando Sentinel to be of interest (well, most of it) because it raises in a public and visceral way the question at the heart of the weight-loss "debate."

To wit: If Oprah Winfrey, with all her money and personal chef and personal trainer, can't keep the weight off, who can?

According to the story,

Oprah, by her own admission, has tried everything.She tried the Atkins diet, she tried diet pills. She tried the Scarsdale diet, the banana, hot dog and egg diet. She tried a 1,000 calorie a day diet. She tried Weight Watchers, Diet Work Shop and Diet Center. She tried Nutri-System.

Yep, and still her weight goes up and down.

The story quotes a dietitian who says, "The longer you do this over the years and get into this classic yo-yo dieting syndrome, the more likely you are to end up with metabolic chaos." Thank you, thank you. It's nice to see the truth in print occasionally.

The reporter goes on to say

But the key to losing weight permanently, experts say, is to figure out why you overeat. Do you eat junk food when you're depressed? When you're stressed out from work? When you break up with a boyfriend or girlfriend? To figure out what triggers your overeating, keep a journal.

(For the record, Oprah has kept a journal for years -- and opined publicly about how you need to understand how emotions play into your eating habits. It's not clear how much it has helped.)

Maybe that's because fat people are no different from thin people when it comes to emotional eating. Show me a thin person who never takes comfort from a plate of warm mac and cheese or a slice of chocolate cake, and I'll show you someone who's lying--to themselves or to you.

Emotional eating is no different from emotional sex, emotional TV watching, emotional long-talks-with-a-friend. They're all part of life.

There's a difference between emotional eating and binge eating. I know, because I've done both. It's been about 10 years since I binge-ate, and in that time my weight has come down maybe 25 or 30 pounds. But I'd still be considered obese by the BMI charts.

It would have been nice if the reporter followed up on the ideas she raised--that very few people can lose a lot of weight and keep it off, that dieting is part of the reason. It would have been nice if the word genetics was mentioned anywhere in the story.

But it's a start. Of sorts.

Mississippi 282, RIP

From ClarionLedger.com:

A state lawmaker on Monday promised a quick death for a bill that would prohibit Mississippi restaurants from serving obese people.

House Public Health and Human Services Committee Chairman Steve Holland announced his intention to kill House Bill 282. The proposed legislation has outraged advocacy groups critical of the legislation and intrigued the national media.
"It's dead on arrival at my desk," Holland, D-Plantersville, said in a news release. "While I appreciate the efforts of my fellow House members to help curb the obesity problem in Mississippi, this is totally the wrong approach."

The bill filed by State Reps. Ted Mayhall, R-Southaven, John Read, R-Gautier, and Bobby Shows, D-Ellisville, would make it illegal for restaurants with more than five seats to serve people who are obese. The criteria for obesity would be set by the state Department of Health, and restaurants that do not comply would have their permits revoked.

The legislation has been referred to a subcommittee, where Holland said he will use a "pocket veto" to kill it. It would have advanced to his committee if it had survived.

Mayhall said Monday he wouldn't vote for the bill. He said he and his colleagues filed it to bring attention to the state's obesity problem, but he never expected to hear from so many people. Media from New York, Australia, London and Ireland have called him since The Clarion-Ledger reported on the bill Sunday, he said.

"You take food away from fat people ... my gosh," Mayhall said.

Obesity makes people more susceptible to diabetes, which puts a further strain on the state's financially-challenged Medicaid program, he said.

A 2007 report put the state's obesity rate at 30.6 percent - the worst in the nation.

Dr. Ed Thompson, state health officer, has previously said Mississippi's obesity rate cost Medicaid alone $221 million each year.

But the National Association to Advance Fat Acceptance issued a news release Monday blasting the bill as "a clear and shameless violation of (Mississippians') human and civil rights."

The group described itself as a "nonprofit human rights organization dedicated to improving the quality of life for fat people," and urged voters to boot the lawmakers who filed the legislation.

"These men are wasting their time, which is your money, and could potentially bankrupt your state. Are these the kind of men you want to continue to represent you?" the news release said.

In a separate news release, the Coalition of Fat Rights Activists president Paul McAleer said the bill would "have substantial and negative side effects on Mississippi's economy and health."

"Anyone who supports human rights and freedoms should be opposing this bill - and any subsequent bill," he added.

Cheryle Evans of Clinton said the legislation is "very short-sighted." She said restaurants should be required to provide details of calories, fat grams and carbohydrates on their menus instead. Evans also said more bike paths and sidewalks should be made available.

Holland, who has described himself as obese, said, "I am working on my own health issues, and I need to do that. I think (Gov. Haley Barbour's) take on this is a good idea. Let's all go walking instead of trying to tell restaurants who they can serve."

Barbour appears in television commercials that promote physical activity. Last session, state lawmakers mandated exercise and health education for students in kindergarten through middle school.

One Reason I'm not Voting for Obama

"Reducing obesity to 1980 levels will save Medicare $1 trillion." -- Barack Obama

Now a new study, as reported by Junkfood Science, calculates that reducing obesity actually costs governments more money in the long run.

What the study really points out, says JS, is the ridiculousness of coming up with such estimates in the first place. And I would add, the moral sledgehammer of using them in sound bytes, to make points that truly do not exist.

We've already had a president who fudges with spectacular ease and seeks to impose his own moral code on all of us. Please, let's not have another.**


**Oh, wait, do any of the candidates pass this test?

Quote of the Day

The "serious problem" [House bill 282] clearly calls attention to is the erosion of basic civil and human rights as war is continually waged against a segment of our population.


From the Association for Size Diversity and Health, in a response to Mississippi House Bill 282, which seeks to bar restaurants from serving food to anyone considered obese by the Mississippi state department of Health. For more, visit ASDAH's website.

For God's sake, repeat after me: There are no bad foods

That's what I feel like saying to the idiots who now want to "salvage" the ridiculous Mississippi bill that would prohibit restaurants from serving food to people considered obese.

Who will be labeled obese, and by whom? Let's not even go there. For now, let's stick with a higher power of absurdity, worthy of Beckett, and talk about the latest twist on this bill: Use it to Save the Children.

Forget about saving the adult fatties, according to this latest spin; let's stick to saving the innocent children. Under the new provisions, children would not be allowed to eat in certain fast food restaurants without a parent present. (Sounds like the concept behind R-rated movies, doesn't it? Do you know the danger you child is able to be exposed to?)

According to John Banzhaf, the idiot behind this new spin,

obese children would still be permitted to order most of the items on a fast food menu. "For example, at McDonald's, even a Double Cheeseburger and Quarterpounder, or a Filet-O-Fish or McChicken, has fewer than 500 calories. Those food items the child should not be served include: the Double Quarter Pounder With Cheese (740 calories), Premium Crispy Chicken Club Sandwich (660 calories), several deserts [sic], etc.

What's the cutoff here? 500 calories = OK, 600 calories = instant obesity?

Banzhaf, a professor of public interest law at George Washington University, needs a lesson in psychology. Actually he needs lessons in a whole lot of other fields, but let's start with psychology. Does the term forbidden fruit hold any meaning? How about banned books? See, we humans are constructed to always want what we cannot have.

And when it comes to food, that goes double. The biggest reason why 95% of diets do not work is that depriving yourself leads to later cycles of binging. You tell your body it can't have chocolate, and watch your chocolate cravings soar. Whereas if you tell your body, Chocolate's fine, no big deal, work it into your day if you really want it, well, your chocolate consumption will over the long term drop. A lot.

Do we really want a double quarter pounder with cheese to become the Holy Grail of a generation of children? Cause that's what will happen should your ridiculous plan come to fruition.

Here's another pearl of wisdom: The more we try to micromanage our metabolisms, the more badly we fuck them up. Dieting leads to eating disorders and even more weight gain. How about, instead of banning foods like they were chapters of Lady Chatterley's Lover, we invest in teaching children the joys of intuitive eating?

Oh, yeah, that would take a complete cultural paradigm shift. And it wouldn't make for such a great sound byte.


P.S. I don't eat at McDonald's; I don't like their food. My kids have never eaten there. I'm not a shill for the fast-food industry. I'm a reasonable human being who believes that people come in all shapes and sizes, that you can be fat and healthy, and that discriminating against and humiliating fat people seems to be the new national sport. Whatever happened to baseball?

And now, a word from NAAFA

Oakland, CA – The National Association to Advance Fat Acceptance, a civil rights organization fighting discrimination against people of
size strongly opposes the Mississippi House Bill 282. This bill
introduced by Representative W.T. Mayhall, Jr., a retired
pharmaceutical salesman with DuPont-Merk, and co-authored by Bobby
Shows, a businessman, and John Read, a pharmacist, would prohibit
restaurants with more than 5 seats from serving people who are
determined to be obese by standards set forth by the Department of
Health. Said restaurant owners who choose to ignore this bill if
passed into law would be subject to fines and/or closure. NAAFA calls upon the union leaders of the food service and hospitality industries to use your influence to stop this bill before it or others like it take your businesses down. If in fact
two-thirds of Mississippians are obese, such a bill could potentially eliminate two-thirds of your customer base, bankrupting an untold number of businesses and potentially impacting a high percentage of your union members/food service employees. NAAFA calls upon the restaurant lobby, gaming lobby and tourism lobby to
exercise your influence in stopping this disastrous bill.

NAAFA calls upon the people of Mississippi to stand up and make your voice heard. This is a clear and shameless violation of your human and civil rights. Flood your governor's office with letters, faxes and phone calls demanding that this bill be stopped in its tracks: Haley Barbour - Governor of MS - 1-877-405-0733 or 601.359.3150, or by mail at: P.O. Box 139, Jackson, Mississippi 39205.

Citizens of Mississippi, these state representatives are supported by your tax dollars. The 2000 Census says 16.2% of your state's residents make under $10,000 a year. The state poverty rate is around 20%. Wouldn't your tax dollars be better spent on representatives who are working to improve the income level of Mississippians? Your state consistently ranks in the bottom three in terms of public school successes. Wouldn't your tax dollars be better spent on representatives who are working to improve the educational system in Mississippi? Who do you think would have to pay for the enforcement of this bill if ratified? The very people who are no longer allowed to eat in restaurants! These men are wasting their time which is your money and could potentially bankrupt your state. Are these the kind of men you want to continue
to represent you?

Our own federal government recognizes that 95% - 98% of diets fail. Weight loss surgeons have admitted that only 5% of people undergoing weight loss surgery ever reach and maintain their weight loss goals. Depriving people of food does not cause them to lose weight in the long term and only increases the risk of ill health. Is our end goal good health and increased longevity or superficial appearance?

NAAFA calls upon every Mississippi citizen above the age of 18 to register to vote and remove these officials from office. Take a lesson from your own state's history. Demonstrate your distaste for prejudice and your disgust with discrimination by denouncing this bill.

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

For more information: naafa_pr@yahoo.com

It's not how fat you are--it's how thin you think you should be

At least that's the gist of an interesting new study that's just out in the American Journal of Public Health.

Lead researcher Peter Muennig, of the Mailman School of Public Health at Columbia University, set out to examine the relationship between stress over being fat and physical and mental health, and found that

the difference between actual and desired body weight was a stronger predictor than was body mass index (BMI) of mental and physical health.

He and his team concluded that

some of the health effects of the obesity epidemic are related to way we see our bodies.


I'll forgo commenting on the assumption that obesity = unhealthiness and will instead applaud Dr. Muennig and his team for at least asking the question.

And I'll pose them another question: What if it's not just internal stress, but external stress? What if judgment and discrimination from the rest of the world affects the health of people who are fat?

We already know that it does, of course, judging by these firsthand accounts.

Might make a good next study for someone. I hope.

Meanwhile, here's more from the Conclusions section of the paper:

If our findings are correct, the policy implications may be counterintuitive. Foremost, if more of the association between BMI is perceptual, some public health messages that advocate idealized body types may be harming their target audience.

Ya got that right.

Concerted efforts to disassociate health messages, such as encouragement of exercise, from obesity stigmatization may circumvent the paradox.

Tell it to Rep. W.T. Mayhall, Jr., who introduced this lovely bill to the Mississippi legislature this week.

I wonder why fat people might feel stressed?

The Dressing Room Project

Thanks to Beth Kanell for tuning me in to this fabulous project, which describes itself as "a girl-powered rebellion to free girls & women
from the bonds of media-imposed standards of beauty."

My favorite one of their quotes, distributed on postcards and buttons:

Worry about the size of your heart, not the size of your body.

It's a little bit of guerilla grrls action. Check it out.

Fat and the law

Clearly I'm naive. I had no idea that it is legal in most places in the U.S. to discriminate against people because of their size or weight.

One reader kindly sent me the text of Wisconsin's discrimination law, as an example:

Prohibited bases of discrimination. Subject to ss. 111.33 to 111.36, no employer, labor organization, employment agency, licensing agency or other person may engage in any act of employment discrimination as specified in s. 111.322 against any individual on the basis of age, race, creed, color, disability, marital status, sex, national origin, ancestry, arrest record, conviction record, membership in the national guard, state defense force or any reserve component of the military forces of the United States or this state or use or nonuse of lawful products off the employer's premises during nonworking hours.

Nothing in there about size or weight, which makes it one of those little discriminatory loopholes we'd love to close up.

As a child of the 1960s, my first impulse is to stage a sit-in. Luckily, there are already folks working on this in much more sophisticated ways. Paul over at Big Fat Blog reminds me about COFRA's Fat Fifty project, which will aim, once it's up and running, to put every state's discrimination statutes, fat-related court cases, and other info on record as a first step toward changing them.

What a great project. And it means I don't have to reinvent the wheel or picket the Wisconson state capitol. Yet.

Y'all get involved now.

Follow-up

Thanks to everyone who posted advice for our anonymous reader. I got this email from her today, and post it here with her permission:

I have great news! I went into the meeting today with my girlfriend (not having the opportunity to have read any of the blogs on your site yet) and the rehab counselor was so sweet. She really focused on making up for the past Counselor's actions. Which was awesome for me. I didn't want to revisit that traumatic day at all.

My girlfriend and I felt no homophobia at all. I went in as my confident self and it seems like she approved me for their services. Because from how she was talking, she talked about the future. Not using the word "if," she used the word "when" repeatedly: When we work down the line together, or when you receive future correspondence, do this and do that. She's mailing me my plan. Wheeeeeee!

I am so so so happy. I can get past all of it and not have to deal with the trauma so much. No lawyer would take it because it's not illegal to deny based on size or weight. Which really is wrong because it's my disability that took away my active life and the weight poured on. I felt I had to fight and fight and that's something I can't do now, I'm fighting three other discrimination situations. I am a bubbly person, I am a fighter, but a person can only handle so much in life before you lose the happiness or time for family. I feel like my own Erin Brockovich. It's hard to encounter so much daily hatred for being fat, lesbian and in a wheelchair. I can handle hatred, it took me from being bitter, to making me stronger, it isn't right or humane, but it is what it is. I can only pray to God for strength and remember The Serenity Prayer everyday.

My goal in life is to help people. I am not in it for me, I want to do social work. Well, I guess feeling great about helping others is in it for me. I did on my own get my local post office to widen their doors and they did a whole reconstruct for disabled people. It took me half a year, but the disabled can feel like everyone else and buy stamps or conduct business. Woohooo!

I really love people and I try daily to be kind, generous and loving to people and that teenager or that old person who looks at me and laughs, snickers, or rolls their eyes, I thank God for, because it makes me thankful to be alive! To feel. To appreciate the people who do love me and accept me. Thank you, bless all of you, and I will keep you posted.

A happy ending, at least for now.

But tell me, the lawyers among us, is it truly legal to discriminate based on size and weight?

Advice for a reader? Please weigh in

I got the following email from one of my readers. Names have been changed or omitted to protect her privacy. Any advice for her?

I live in [state name removed]. I am fat and lesbian. I am disabled and use a power wheelchair for assisted mobility for my daily needs. I have been able to get myself enough courage to apply for city college courses, but I didn't get enough funding from financial aid, so I was directed to go to the Deptartment of Rehab by my local Center for Independent Living Advocate.

I called Rehab and made the appointment. I met with the counselor last October. My girlfriend was with me and from the moment the counselor laid eyes upon me, he gave me this disgusted look. He made his decision to deny me services in his mind but invited me into the office. He took five minutes interrogating me, belittling me and then said you're too fat, too disabled and no one will ever hire you in a wheelchair. He said the only way I could get help from Rehab was to get gastric bypass surgery and lose the weight first. He continued to cut me down by saying I was no better than a criminal who gets out of prison and asks him to buy his clothes, shoes and socks.

My girlfriend was there to get help too, but he scared her so badly she was afraid to say one word to this militant gatekeeper. I am so traumatized still by how he was to me. I immediately complained to The Center for Independent Living and I was told to complain to their CAP Advocate. I complained to him and he has yet to help me. I feel discriminated against because of being fat and lesbian. Since October the CAP Advocate has been playing games with me; I went to his supervisor and he too won't call me back or do anything.

I called Rehab, complained, and got a new counselor, a woman. I am supposed to meet up with her tomorrow and I don't know what to expect. That denial of services in Oct. 07 caused me not to be able to start school Jan. 08. Now, I want to start college in the Fall 2008 and this replacement Counselor can do the same and ruin my chances based on my weight, disability and sexual orientation.

I refuse to get down and depressed. I am going to stand up for what I know is right. I've worked all my life being fat, it never affected my work. I excelled at anything I did. Just because I'm in a wheelchair shouldn't matter with non manual labor.

What do you think I should do?

--Worried and Upset


Anyone out there know the law on discrimination or have any practical advice for this reader?

And while we're on the subject of mixed messages . . .

Read this story from a news station in Tennessee.

They can't quite get the story straight, can they? Is it the scary overweight teens, or is it the scary eating-disordered teens?

Oh, and P.S.: By the time you notice changes to someone's hair, nails, and teeth, they're deep in an eating disorder. If you want to be helpful to parents, give them some earlier warning signs to look for, like preoccupation with cooking, excuses for not eating, cutting out whole categories of food, using the bathroom after every meal, etc.

Miss America

Kirsten Haglund, just crowned the new Miss America, talks movingly about her recovery from anorexia at age 16 here.

She doesn't talk about how much she weighs, to avoid triggering other teens. She does talk about having curves, and liking them. She alludes to the horror of anorexia without going into other details.

I'm no fan of the whole Miss America pageant thing. Still, I'm with her right up until the line where she's quoted as saying that while she isn't about to "let myself go," she won't be skipping any meals.

Kirsten, you have the chance to do a lot of good as an emissary from the hellish lands of eating disorders. Please, next time, skip judgments like this. Remember that bodies come in all shapes and sizes, and that many of the young women you'll come into contact with this year will never, can never look like you. And that that doesn't mean they've "let themselves go."

Use your powers for good.

An incredibly sad story

This interview with a nun who's been anorexic for 50 years is one of the saddest things I've ever read. Sad because of Sister Marie Therese's childhood experiences, which no one's child should ever have to go through. Sad because of her tormented young adulthood.

Most of all, sad because of these lines:

Anorexia has been a part of my life for more than 50 of my 61 years. It has been a friend really. Having it is like being with somebody who takes away your feelings.

For parents whose children are struggling with anorexia right now, this is what's at stake. This is the reason to tackle the demon of an eating disorder head-on, right now, while your child is still in his/her teens, while s/he can still recover and go on with a normal life.

This is what no parent wants for their child.

Walt Kaye, M.D., believes in families

Dr. Kaye, a professor of psychiatry and director of the Eating Disorders Program at University of California-San Diego, is leading a team in one of the largest studies on eating disorders ever done. The study will include seven sites around the world and will compare two kinds of family therapy to explore the question of which kind of family therapy is best for which families.

Note to eating disorders therapists and programs: The question in this study isn't whether families should be part of e.d. recovery. It's how.

Patients will be assigned to one of two treatment types: systemic family therapy, which looks to improve relationships within the family as a means to recovery, and family-based treatment, also known as the Maudsley approach, which empowers the family to help the child recover.

One of the biggest perceived obstacles to Maudsley treatment is the notion that families have to be "perfect" in order to implement it. Well, that and the traditional notion that families cause eating disorders in the first place, and so cannot possibly be part of the solution.

The trouble is, traditional treatments stink. They condemn sufferers to years of semi-starvation, partial recovery, and inevitable relapse. So far, the Maudsley approach is the single most effective treatment for teens, with five-year recovery rates between 80 and 90 percent.

If a better treatment came along, I'd be the first to do the happy dance. What I can't stand is people who shoot down the notion of families being involved in treatment on general principle, or because it's always been done that way, or because they've always done it differently and can't make the leap to a new paradigm.

Children deserve the best treatment out there. Research shows that if someone with anorexia is ill for less than three years and then recovers, her chances of a lifetime free of this devastating illness are excellent. But those who've been chronically ill for 5 years, 10 years, 15 years, are much less likely to ever really recover.

And that's simply wrong. Especially when there are tools that can help--like the family.

Anyone who's interested in being part of the UC-San Diego trial can call 858-366-2525 or e-mail edresearch@ucsd.edu.

What does it all mean?

A reader named Moira wrote in on another thread, and I thought her comment deserved its own post:

Hi. My name is Moira, and I couldn't help noticing your comment that the BMI for overweight was lowered to 25 and obesity at 30. I've also noticed in my line of work that doctors lowered what the accepted upper limit for blood pressure should be as well, from 140/90 to 130/80. And just the other day I was called full figured for the first time in my life. What does it all mean? Is there someone out there who wants me to believe that every one of us has a problem needing intervention when we might just be fine as we are?

In a word, yes I do think that. Think about how other criteria have changed over the last decade or so, too, from cholesterol guidelines to blood sugar guidelines to weight guidelines. Ask yourself if it's really credible that most adults in the U.S. need to be on medication for cholesterol, high blood pressure, and other issues. Then ask yourself the classic question in any criminal case: Cui bono? Who benefits?

Big Pharma benefits, that's who. The health care industry benefits from the medicalization of all kinds of things, from childbirth to body size. Maybe it's useful to see the current anti-obesity hysteria as part of this overall trend toward pathologizing normal human variances and processes. After all, as soon as you identify a "normal" range of anything, you automatically create an "abnormal" range as well.

What do you all think?

Support group meeting tonight

Sorry for the late notice--the Madison, Wisconsin support group of parents of children with eating disorders is meeting tonight. This is a loose, informal group that i've convened. We share resources and support, especially around family-based treatment (the Maudsley approach). Please stop by if you're in the area. The meeting is at Barriques on Monroe Street at 7:30.

A little question of semantics

When I showed my daughter the NYT piece on the fatosphere the other day, her only comment was, "But you're not fat."

What she meant, of course, was "You're not that fat."

Put me next to, say, Ellen Pompano, and I certainly look fat. Put me next to someone who weighs 400 pounds and I don't look fat. Or I don't look as fat.

Fat and thin are words that exist mainly in relation to each other. At the extremes of each range we can certainly identify them correctly. But in the vast middle, our judgment becomes much more relative.

Semantics plays a role in the current anti-obesity hysteria. For starters, the definitions and rules changed in 1998, when the cutoff for overweight was lowered from 27.3 to 25 on the BMI chart. Bingo--instant overnight overweight for millions.

As Paul Campos has pointed out in The New Republic, the way we talk about fat and thin, oveweight and obese and underweight, is something of a shell game.

Fat qua fat is not the problem. Because, after all, we all have fat on our bodies. What's more, we need fat. Without it, your body doesn't work well and your brain sure as hell doesn't work right. I've seen the evidence up close and personal, and it's not pretty.

Think about it the next time you find yourself saying, "But I'm so fat!" or the next time you look in the mirror. Come back and tell me how it changed your perception.

We interrupt this blog to tell you

that I've had to enable comments moderation for the time being, due to an influx of ungrammatical and highly offensive comments.

Sorry for the inconvenience. I'm sure they'll find someone else to pick on soon and stop leaving their illiterate offerings, and then I'll go back to an open comments policy.

Anti-fatism up close and personal

My experience last night with the shock jock from Philly reminded me of an experience I had as a child. I went to an elementary school where we spoke English in the morning and Hebrew in the afternoon, and where pretty much everyone I knew was Jewish. My parents talked a lot about anti-Semitism, but I never encountered it.

Until I entered 7th grade at the local junior high, and one day, as I walked down the hall, a group of laughing 8th graders showered me with pennies and shouted, "Run for the pennies, kike!"

I was so naive I was more puzzled than upset. What was a kike? I didn't even know.

Once I found out, the waves of shame and humiliation took a long time to diminish.

That's how last night's radio show was for me--really the first time I've encountered fatism in such a virulent form, especially as followed up by a commenter this morning. (Alex from Philly, don't even bother. You'll be deleted and go straight to troll hell.) It's hard to take it in when you meet up with such hatred, whether it's based on the color of your skin, your religion, or the size of your waist.

Years after that day in junior high, I realized what's at the heart of all such prejudice and hatred: self-loathing.

If I were a more generous person, I'd feel compassion for all those who spew mindless hatred because they're secretly afraid they themselves don't measure up, because they hate themselves. But you know what? I'm not feeling particularly generous today, so I'll leave it at "I hope you get yourself some help."

Why talk radio sucks

I just learned Media Lesson 101: Never go on a talk radio show without asking who else is going to be on.

When the Dom Giordano Show emailed today to ask if I would come on the show this evening to talk about today's New York Times piece about the fatosphere, I figured it would be the usual five-minute radio interview, with time for a couple of comments about the piece and the fatosphere.

What they didn't tell me is that there was going to be another guest, a fitness trainer and "expert" whom they have on the show often.

Instead of a civil conversation, we had a lotta fatty mudslinging, complete with descriptions of waddling children, fatties who just want an excuse to be obese, etc. I was blindsided by the vitriolic assumptions that got tossed around. It was a classic exercise in thin entitlement and fat-bashing, all couched in the usual "Don't you know fat is unhealthy?" language.

I'm mad at myself for missing some opportunities, because my heart was banging away and my voice was shaking. Nothing like a shock jock to raise the adrenaline level. Not that it mattered--the research I was able to pull out of the air and cite (the 2005 CDC mortality study, for one) just sailed on by as if it didn't exist. And it didn't, you know, because of the waddling children and diabetic fatties who can't get off the couch. When I suggested that you can be healthy and fit even if you're fat, they practically laughed me off the show.

I feel badly about this--I could have done a better job of advocacy.

I hope the rest of you FA bloggers don't get blindsided like this. And I hope there was one person listening who heard a little something new, and might check it out.

Ugh. I'm heading upstairs to do some yoga. What an end to what a day.

Welcome new readers

Some of you have arrived here via the New York Times piece on the fatosphere. Some have come from other blogs, like Shapely Prose or Manolo for the Big Girl or Creamy Nougat Lair. However you stumbled onto this blog, I'm glad you're here.

I hope you'll take a few minutes to read up on the I Love My Body! pledge. Subversive, isn't it? Especially when you think about the messages the rest of the world gives us every single http://www.blogger.com/img/gl.link.gifday. Lose weight. You're too fat. You're worthless if you're fat. Thin = pretty. Thin = sexually attractive. Fat is repulsive, dangerous, unhealthy, ugly.

Here at Feed Me!, we believe in Health at Every Size. When our friends make comments filled with self-loathing, we talk them off the ledge. We believe that each and every one of us deserves a joyful, competent relationship with food.

I've been researching and writing about issues of weight and body image for several years, including this story about my daughter Kitty and her struggle to recover from anorexia. I'm putting together an anthology of essays about these issues, called--what else?--FEED ME!, which will be published by Random House next December.

I'd love to hear from you. What's your relationship with food and eating and your body like? What challenges you and what brings you joy? Share it with the community here. You won't be sorry.

Love Your Body!

As Camryn Manheim said, This is for all the fat girls. And the thin girls. And the in-between girls who struggle, as so many of us do, with self-loathing.

Well, here's a way to fight back.

Print this out. Use it as a bookmark. Tape it to your fridge. Frame it for your bedside table. Say it out loud.

I promise you, someday you'll actually believe it.

In honor of MLK Day

And in the context of the ongoing discussion about fat acceptance as a civil rights movement, here are some excerpts from Dr. Martin Luther King Jr.'s "Letter From Birmingham Jail." This particular section addresses the question so often asked in the civil rights movement of the 1960s: Why not just wait, things are getting better, why push it? King's eloquent and beautiful response is moving and righteous.

We still have so long so go for racial equality in this country. And if, as you're reading King's words, you imagine the word fat everywhere he writes Negro, and thin for white, you might get a taste of the work that still needs to be done on other fronts, too.


Letter From Birmingham Jail
April 16, 1963

You may well ask: "Why direct action? Why sit-ins, marches, and so forth? Isn't negotiation a better path?" You are quite right in calling for negotiation. Indeed, this is the very purpose of direct action. Nonviolent direct action seeks to create such a crisis and foster such a tension that a community which has constantly refused to negotiate is forced to confront the issue. It seeks so to dramatize the issue that it can no longer be ignored. . . . I must confess that I am not afraid of the word "tension." I have earnestly opposed violent tension, but there is a type of constructive, nonviolent tension which is necessary for growth. Just as Socrates felt that it was necessary to create a tension in the mind so that individuals could rise from the bondage of myths and half-truths to the unfettered realm of creative analysis and objective appraisal, so must we see the need for nonviolent gadflies to create the kind of tension in society that will help men rise from the dark depths of prejudice and racism to the majestic heights of understanding and brotherhood.

The purpose of our direct-action program is to create a situation so crisis-packed that it will inevitably open the door to negotiation. . . . My friends, I must say to you that we have no made a single gain in civil rights without determined legal and nonviolent pressure. Lamentably, it is an historical fact that privileged groups seldom give up their privileges voluntarily.

We know through painful experience that freedom is never voluntarily given by the oppressor, it must be demanded by the oppressed. . . .

Let us all hope that the dark clouds of racial prejudice will soon pass away and the deep fog of misunderstanding will be lifted from our fear-drenched communities, and in some not too distant tomorrow the radiant stars of love and brotherhood will shine over our great nation with all their scintillating beauty.

Yours for the cause of Peace and Brotherhood, Martin Luther King, Jr.

Et tu, Prevention?

It's been a while since this magazine geek has looked at Prevention magazine. What I remember from the last time--maybe 10 years ago--was that Prevention was a pretty good health-related magazine, with in-depth articles, exposés, thoughtful journalism, and some reader service--the tips and tricks kinds of articles.

This evening I looked it up online; I'd been told there was an article in the current issue I should see. I got to Prevention's home page, and was immediately assaulted by the following headlines:

Kick-Start Your Metabolism!
Flat Belly Diet! Tips to Shed Pounds Fast
Eat Chocolate to Lose Weight
Calculate Your BMI
Eat Healthfully and Fight Disease
Heart-Smart Foods
Melt Fat With Every Step
Lose Up to 15 Pounds in 32 Days
Eat Up, Slim Down

Dear editors: There's more to life than obsessing over fat and weight loss. You'd think, reading this page (and this was just the home page--there's more farther in), that losing weight was the only meaningful measure of health.

Seeing it like this was a visceral reminder of our national obsession, and just how unhealthy it is.

How you eat is also how you live

Dietitian and therapist Ellyn Satter has been writing about food and eating for years. I often think of her words when I think about my own or others' eating troubles. According to Satter, the goal for all of us is to have "a joyful, competent relationship with food." Years of research have helped her define what it means, exactly, to be a healthy, competent eater:

Competent eaters have positive attitudes about eating and therefore are relaxed about it. They enjoy food and eating and they are comfortable with their enjoyment. They feel it is okay to eat food they like in amounts they find satisfying.

These three little sentences are about as radical as the Declaration of Independence was 225+ years ago. Consider all the ways in which our culture doesn't encourage us--especially women--to enjoy food, to feel it's OK to eat food we like in amounts we find satisfying. So many of us are terrified of food and of our own appetites; this little manifesto puts the power squarely where it belongs and where it always has been: with us.

Satter's latest newsletter takes her research a step further, in a direction I find very interesting indeed:

Competent eaters do better with feeding themselves and have positive health indicators. None of that surprised me. What did surprise me, although it shouldn’t have, is that competent eaters are emotionally and socially healthier than people with low levels of eating competence. They feel more effective, they are more self-aware, and they are more trusting and comfortable with themselves and with other people.

That's right, folks: Being competent with eating correlates with emotional and social health. Not dieting. Not weight loss. Not binge eating. But maintaining that joyful, competent relationship with food and eating.

Satter goes on to explain the connection:

Consider that being emotionally and socially healthy--emotionally competent, if you will--depends on being sensitive to and comfortable with what goes on inside you--knowing what you feel, what you want, who you are--and being honest with yourself and with others about it. Your comfort and honesty with yourself allow you to act on your feelings in a rational and productive way. You can appreciate not only your own feelings and wishes but those of other people and, as a consequence, be reasonably adept at working things out. Being competent with eating depends on exactly the same processes: being sensitive to and comfortable with what goes on inside you and being honest with yourself and others about it.

Amen, sister.

Hitting a nerve

Back in October I posted about some of the marketing brochures I collected at the NEDA conference. I singled out one from Rogers Memorial Hospital, partly because it was so egregious and partly because Rogers is the closest residential treatment center to my town, and it's the place my daughter likely would have gone had we chosen in-patient treatment for her.

I've been meaning to post the follow-up to that thread, which was that I got a letter from the COO of Rogers Memorial himself. Here for your edification are some quotes from the letter, along with my commentary.

Quote: Your comments and suggestions for improving our brochure have already been received by our marketing department and will weigh in our minds when we revise our eating disorder materials in the future.

Commentary: The point wasn't a critique of the brochure; I was discussing the program. Big difference. Revising the marketing materials isn't going to change your outcomes for the real live people who go to Rogers. Point well and truly missed.

Quote: We would appreciate the consideration of sending us such criticism directly, rather than taking your complaints immediately and directly to a public forum like your website.

Commentary: I'm sure you would. And I'm sure, had I called you with my "complaints," you would have taken them very seriously indeed.

Quote: Advocates for mental health must work together to achieve greater awareness and to break down the stigma that our society attaches to mental health disorders.

Commentary: I'm with you on that one . . . though I think my notion of advocacy is probably not the same as yours. To me, advocacy means empowering patients and their families with accurate and true information, true choices, and effective treatments.

Quote: Schedule a visit to our campus and really get to know our medical staff and administrators who have trained and practice Maudsley approaches and techniques when they are applicable.

Commentary: It's those last four little words that give it away: when they are applicable. Family-based treatment is the standard of care for adolescents. It should be the norm rather than the exception.

I know there are caring staff at Rogers Memorial. I challenge them to take a hard look at their treatment protocols for teens and evaluate them in the light of evidence-based research--then come up with a new vision. You have the potential to do a lot of good. I'd love to see you doing it.

Civil rights

I just wrote this in a comment on another post, and thought it was worth repeating in a post all its own.

We need a civil rights movement for fat people.

Fat acceptance is great, but we need to go a step further. We need our own Rosa Parks and Martin Luther King, Jr. and Mahatma Gandhi. We need civil disobedience. We need to picket outside the offices of for-profit bariatric surgery clinics. We need to Act Up, not shut up.

We need to teach our own culture an essential lesson once more: That each and every person is a valuable human being, regardless of the color of his/her skin, intelligence, country of origin, gender, sexual attractiveness, or weight. Hell, we need our own song.

We're talking basic civil rights here. Who's on the bus?

Part 2: Obesity and insurance

Part 2 of my local paper's coverage of bariatric surgery starts like this:

If you smoked a pack of cigarettes every day for 20 years, you might develop lung cancer. Most insurers would pay for surgery and other cancer treatments without quibbling over it.

But if you gradually piled on weight, then developed diabetes or other problems from obesity, your health plan likely would not cover weight-loss surgery without a fight.


Shocking, isn't it? A medical condition insurance companies don't cover. (I'm putting aside for the moment the underlying assumptions here: obesity = medical condition/disease, obesity --> diabetes and other diseases, obesity is volitional.) How could this be, you wonder?

Alas, I don't have to wonder. Two years ago I fought with our insurance company--and lost--over its coverage of my daughter's treatments for anorexia. Because anorexia is considered a mental illness, and because our progressive-in-reputation-only state does not have mental health parity, our insurer got away with covering only a small percentage of the cost of my daughter's treatment.

Where were the incredulous newspaper stories then? Where was the hue and cry, the uproar at the injustice?

Uh-huh. I thought so.

Of surgery and blame

There's nothing new about bariatric surgery, even in the midwestern outpost I live in (once a New Yorker, always a New Yorker!), but this front-page story in this morning's paper made me see just how mainstream it's becoming--so mainstream that health insurers here are beginning to cover it.

The good news is that the story focuses on the risks of weight-loss surgery: internal bleeding, bowel obstructions, leaks in the new pipeline, blood clots, and cardiac complications. The local hospitals that do the procedures have complication rates about the national average--between 8 and 11 percent. (I wonder how this compares with complications rates of other kinds of surgery; anyone out there know?)

What made me sick was not just the literal description of the surgery, though that was graphic and disturbing. It was the curiously familiar rhetoric that accompanied the story's generally positive view of these procedures:

". . . some doctors [say] patients are looking at the surgery as an easy solution.

'I see a lot of people who are in a miserable situation, and they 're looking for a solution, and surgery seems like an easy solution,' said Dr. Edward Livingston, a bariatric surgeon at the University of Texas Southwestern Medical School in Dallas.

'But this is a big life change. It requires a great deal of investment on the patient 's part to make it work.'"

Sound familiar? It should. Like so many other diet pills and weight-loss plans, it comes with a heaping helping of guilt and blame: You say people are miserable and are just looking for an easy solution? How dare they! They should be made to suffer.

And suffer they will, if they have bariatric surgery. If they're lucky, like the woman profiled at the top of this story, they will get to go off their meds for diabetes, sleep apnea, etc. Assuming, of course, they were on them in the first place. If they're lucky, they won't die as a result of the surgery or have complications that cause them long-term pain and disability.

And even if they are lucky, they're still likely to face buyer's remorse. "This is a lifelong commitment, and there are going to be days when you're sorry you've made this commitment," says the woman profiled in the story.

I bet. I find the word commitment to be an odd one here. What we're really talking about is a procedure that mutilates the human body, with long-term consequences like absorbing 77 percent fewer nutrients from food--for the rest of your life. That's not a commitment; it's something you endure.

But the underlying assumption, here as elsewhere, is that there's an element of choice about being obese. And that's what I find frustrating and upsetting, that our culture assumes that whenever you deviate from the cultural norms around weight, it's your fault. Whether you're obese or anorexic, you are to blame, and you are to be punished.

If I were a therapist, I'd have to ask: How does this help us? What's the secondary gain of seeing weight as a reflection of intention, behavior, and responsibility?

These are the kinds of questions that stories like this one should be asking.

Anorexia and target weights

Doctors do a lousy job, overall, at setting target weights for people recovering from anorexia. Most set them way too low, so the patient never reaches or stays at a weight high enough to heal from prolonged malnutrition, and relapses.

Now a new study published in the International Journal of Eating Disorders suggests a different measure of recovery: resumption of menstruation.

As nearly any pediatrician or parent can tell you, this is a bad idea. Really bad idea. Some girls never lose their periods no matter how much weight they lose. Some get them back while they're still significantly underweight. Getting your period back while you're in recovery is a good sign, but it's no litmus test of health.

In fact there is no single measure of restored health. Some clinics use body composition analysis, which takes into account not just a person's weight or BMI but also the percentage of lean and fat tissue in the body.

I think the best measure is mental health, and parents are well-placed to judge it. They know what their child was like before anorexia, and they know when their child is "back." I've heard countless stories of teens who reach the weight the doctor sets and still aren't better, or who get their periods back despite still being in the grip of anorexic delusions and obsessions.

When I saw my daughter's anxiety around food and eating was pretty much gone, I knew she was close to full recovery. Don't settle for anything less.

And the winners are . . .

You all could be making tons of money as high-paid marketing shills for Big Pharma. But I'm glad you're not.

And the winners of the Taranabant marketing slogan contest are:

Letitshine's "Taranabant: Because food is bad." Because, you know, that's what people really really think, deep down.

bigmovesbabe's "Taranabant: Because nothing tastes as good as anxiety feels." For its social satire of That Other Tagline.

And finally, littlem's "Taranabant: Rimonabant Duzn't Wurk On Fattiez, So We Tryz Agen" just because I think it's hilarious. And oh so true.

I'll award more prizes if you keep the entries coming. Meanwhile, congratulations to our 3 lucky winners. Send me your address and T-shirt size and I'll send you a prize. :-)

Would you rather be fat or have a mood disorder? Win a prize!

Because those are your two choices, if you listen to the hype around the latest in the slew of anti-obesity sweepstakes entrants, known generically as taranabant. Amid the hysterical buzz that's been making the rounds online, we're now beginning to see mention of "psychiatric side effects." This Scientific American article describes side effects as "nausea, vomiting, and moodiness," and goes on to explain that taranabant is what's known as a cannabinoid antagonist, meaning it blocks the receptors in the brain that are activated by cannabis sativa, or pot. So instead of giving you the munchies, this drug takes away appetite; instead of calming, it "activates," or makes people irritable and anxious.

But wait--I have a better idea. And you can win a prize! Keep reading.

Can me say first how much I hate the photo and headline that ran with this story, too? The head was "New Diet Drug in the Battle of the Bulge," and it ran with this image.

My interpretation of the phrase "battle of the bulge" is people who want to lose 10 or 20 or 30 pounds—who want to be in the lower end of their setpoint range rather than the higher end. This is hardly what even the medical profession would label "obesity." I suppose this image is better than the one that ran with a report on a site called Dogflu.ca., which I'm not going to reproduce here because it's so exploitative.

I think we need an anti-anti-obesity drug marketing campaign, and drugs like this give us the perfect material. We could start by resurrecting the old "This is your brain on drugs" ad campaign. See the fun that's possible?

Let's have a little friendly competition, in fact. You write a clever tagline to go with this new drug, and I'll send a prize to a couple of lucky winners. Ready, set, go.

Why we need to talk about food

Over at Laura Collins' blog there's a compelling debate raging about treatment for eating disorders. It started with a link to a Student Doctor Network discussion about Maudsley (also known as family-based treatment).

The forum link is a peek into the minds of some medical/psych students who dismiss Maudsley treatment as something that might work only for "the very tame cases" (has anyone out there ever seen a "very tame case" of anorexia?). Students who know nothing about it say confidently that they would "never recommend it."

I would think that given the truly abysmal rates of recovery from eating disorders, medical professionals would be thrilled to learn about a treatment with positive results and an excellent track record. I've got a couple of suggestions for where to start: With this useful Q&A on Maudsley and this article about the University of Chicago's Daniel Le Grange.

And in answer to a comment made on the Student Doctor Network, I love what Dr. Le Grange says at the end of the article: "How can you not talk about food when your daughter is starving?"

Pop quiz

What's the first thing that pops into your head when you think about eating disorders? Or see someone who's clearly struggling with anorexia or bulimia?

A. "What a selfish brat--why doesn't she get a life?"

B. "What a dreadful illness this is--I know how much she's suffering"?

The answer most likely depends on what you know--or think you know--about eating disorders.

If you think they're emotional responses to trauma or lifestyle choices, you probably answered A. If think they're physiological diseases that are no fault of the patient and can't be chosen (or unchosen), you probably chose B. And you'd be correct.

As Cynthia Bulik, professor of eating disorders and psychiatry at University of North Carolina, put it, "“There is a lot of false information about anorexia nervosa disseminated in pop culture. This study suggests that even a nugget of accurate biological information can influence how health care professionals perceive the illness."

And not just doctors and nurses but real people, too, according to the experiment Bulik is commenting on. Attitudinal change comes hard, but it does happen. Read and rejoice.

Body image/sexuality 101--for teens

Here at Feed Me!, I get a lot of books sent to me by publishers and authors who want some blogosphere buzz. I write only about the ones that really move me--negatively or otherwise--because life's just too short to bother with the rest.

Body Drama by Nancy Amanda Redd is the most recent submission that's come my way, and I thought it would be perfect to try out on my two teenage daughters. They're a tough audience, as most teens are these days, quick to spot the phony tone and the overly chirpy (and uninformative) information. This book is, as it trumpets, designed for "Real girls, real bodies, real issues, real answers," and its cover features tasteful images of 5 teenage girls in their underwear, along with the tagline "Shape * Skin * Down there * Boobs * Hair & Nails."

I like the book a lot, for its joyful photos of bodies of all shapes and sizes, for its common-sense, practical advice, and for its willingness to take on some tough questions and provide elegant, useful answers. One of my favorite pages shows photographs of 24 different vulvas of all shapes and sizes. "When I study the different vulvas, I see elements of my own here and there, and realize that no one's exactly the same" writes Redd, a former Miss America contestant and Harvard grad. "I also have been able to release a lot of the embarrassment I always carried around about my own vag. I hope that these pages will do the same for you."

But what would my daughters think?

I brought the book down to the living room one afternoon and put it on a table. Within 10 minutes both girls had picked it up--a promising beginning. The 16-year-old dismissed it by saying, "I know all that already." But I noticed she kept going back to it, picking it up, paging through it. The younger one didn't want to pick it up, so I wound up asking her to take a look. She read it cover to cover and told me later, "That book was pretty good."

Bottom line: If you've got teenage or preteen daughters, you might want to buy this book and leave it lying around. At the very least they'll see that not everyone looks like Paris Hilton (thank God).

Why Immanuel Kant was right

A letter in today's issue of the British Medical Journal warns that the obesity epidemic in the U.K. is so bad that action must be taken now; no more studies or research, says the letter writer. Do something now!

What does she think should be done? It's a question of infrastructure, she writes; we need to build more bike lanes and sidewalks and remove the physical obstacles to biking, walking, and swimming.

That sounds like a great idea to me. I live in a city famous for being bike-friendly. I bike to and from work when the temperature is above freezing (round trip: 6.5 miles) and walk the rest of the time, and I love it.

But I haven't lost any weight doing it, and I don't expect to. That's not why I do it. I bike and walk because I love the feeling of getting somewhere under my own steam--always have; I walked to and from high school, 2 miles each way, even though there was a bus I could have taken. My brain works better when I'm in motion, so I get a lot of my best ideas while I'm walking or biking. And the efficient part of me likes combining daily exercise with basic transportation--killing two birds with one stone.

The trouble comes when we pose such social changes as means to an end, ways to drop pounds, rather than an end unto itself. The philosopher Immanuel Kant spoke to this kind of mistake in his writings. In his view, all means to an end have a merely conditional worth because they are valuable only for achieving something else. In order to have value, something must be worth doing for its own sake.

Bingo! Let's build bike lanes and hiking paths and public swimming pools because we think there's intrinsic benefit in people biking, cycling, and swimming. Conflating weight loss with these activities just muddies the waters. What will letter writers propose when said improvements don't result in massive weight loss? I shudder to think.

How to get naked on national TV

My older daughter has been bugging me to take a look at Lifetime's new show, How to Look Good Naked, and last night I finally did. The idea is that any woman can look good naked if she Loves Her Body. It stars Carson Kressley, one of the Fab Five from the Queer Eye for the Straight Guy show of a few years back, and (in each episode) a woman who is unhappy with her body. Like all reality shows, it's based on the premise of quick transformation, only in this case it's not through diet, overexercising, or self-hatred.

In this show, the path to loving your body does include some high-end clothes, a proper bra fitting, and spa time. But it also pays at least lip service to the idea of taking a good look at your body and learning to love what you see, regardless of how you do or don't conform to cultural beauty norms. It's an appealing premise, though I do have to wonder why women require the services of a gay man to appreciate our boobs, thighs, and butts.

Carson Kressley is, as my daughter says, adorable, and much of the dramatic tension of the show comes from the cognitive dissonance of watching a perfectly toned, tweezed, and tucked-in gay man not flinch at the sight of a fat woman in underwear. And the whole show takes on the unfortunate feeling of a scavenger hunt at the end, when Kressley persuades the somewhat-transformed woman to pose naked for the camera. It feels a bit like a frat dare of epic proportions, and I couldn't help wanting the woman to say "No way!"

But even dressed up in TV sham and tinsel, the show has a little nut of true feeling at its core. When Layla, the subject of the first show, talks about how her mother put her on a diet for the first time at age 12, she wipes away tears—who can't relate to that? When she's asked to place herself in a lineup of women in their underwear, arranged by hip size, she vastly overrates the size of her own hips--and who can't relate to that? It's a clever way to illustrate the concept of how differently we look to others and to ourselves. Mostly, the pleasure that shines on her face when she looks at herself in the mirror at the end of the show, coiffed, well-dressed, and most important closer to accepting her body and herself--that's a genuine moment, no matter how fake the trappings.

Of course, the rest of us have to get there without the help of Carson Kressley or thousand-dollar outfits or highlights. We have to look in the mirror and find a way to say, "I'm beautiful just the way I am." Maybe this show will inspire us to at least give it a try.

I'm going upstairs to do that right now.

New Year's greetings, of sorts

My daughter sent me this piece, which ran in our local paper on New Year's Day, along with an email asking, "Isn't this appalling?"

Tha's my 12-year-old daughter, who apparently understands more about the world than the fancy-schmancy newspaper editors around here.

Yeah.

Of course, what do you expect from a column called "The Skinny"?

Please read this first-hand account

sent to me by a mom, describing her daughter's recent experiences in an upscale residential facility for eating disorders:

". . . If my daughter cries in the facility, she is restrained in a punishment chair. If a girl regurgitates food at the table, she has to eat it again. The nurses tell my daughter to try to swallow her vomit at the table so she won't get the punishment chair. Over the past four days, my daughter's typical meal has consisted of two veggie burgers on buttered rolls, three cups (!!!) of canned vegetables, two cups of milk, two bananas, six TBS of peanut butter, and a granola bar, all of which must be consumed within 20 minutes. All food is served stone cold because the pediatric unit has no kitchen. We are allowed one visit per day, during which she cries to come home. . . ."

This is why I'm such a strong believer in family-based treatment (the Maudsley approach). Those of us who have been through the nightmare of anorexia know that you have to be tougher than the eating disorder to help your child survive. You have to allow no loopholes for the disease to continue its insidious mind-twisting.

But you do not have to punish the child. Someone with anorexia is already suffering torments beyond what we can truly imagine. The very concept of a punishment chair makes me feel ill. Eating stone-cold food? Being punished for crying? Who wouldn't cry, trapped in the hell of anorexia? Serving massive amounts of fruits and vegetables during re-feeding? You need the smallest volume possible of food during re-feeding, partly because the digestive system can't handle so much volume and partly because fat is a crucial part of the recovery process. Quality, not just quantity, is important, and the brain and body need fats and protein to begin to heal.

Imagine being ill with cancer and being punished for throwing up after each round of chemotherapy.

Treatment for an eating disorder should never look like medieval torture. There are other ways and options. Even in cases where a child requires an NG tube, treatment can be done with love and kindness and not punitively.

Resolve

Fillyjonk over at Shapely Prose has a great post on New Year's resolutions. Check it out.

This year, I resolve to:

Make progress toward learning to love my body the way it is, not the way I wish it were.

Finish my second anthology.

Sell the guitar I bought last year, and which I've played twice. Take voice lessons instead.

Do something surprising every day. OK, every week.

How about you?

The portable Love-Your-Body Pledge

Thanks to my pal Mary Ketarkus Brown for making the I Love My Body! pledge pretty and portable. Use it as a bookmark, tape it to the inside of your cabinet door or mirror, hand it out on street corners. Say it out loud to yourself once a day. Try to mean it.

Then spread the word.

In loco parentis

Colleges should stand in loco parentis to their students, but when it comes to eating disorders and psychiatric illnesses, they rarely do.

So three cheers for this Cornell University custodian, who went above and beyond the call of duty to get help when she suspected that a student had bulimia.

We've got a long way to go, though. What if the student had refused treatment? Would the college call her parents? Probably not in this current privacy-oriented climate.

Well, it's a start.

Unspeakable

is what this is. Truly. I cannot speak of it. Children being harmed, mutilated, possibly killed, all because they're considered overweight. As one of the so-called surgeons involved says, “I am very pleased that youngsters will soon be offered gastric banding. Of course this will only be in extreme cases when everything has been tried and the child just cannot lose weight...."

And why exactly does a child need to lose weight so badly that s/he must be mutilated? Where does the urgency come from, the pressing need? And just how in the world can a child give informed consent for such an operation?

I don't know which is more sickening, the fat hatred that inspires such vile acts or the profit motive that no doubt encourages these surgeries. Or the thought that someday parents who refuse such surgeries on behalf of their children may be censured or have their children removed from their care.

Where are the yellow stars?

I'm going to throw up now.


Thanks to Sandy Szwarc for posting on this. I think. I'll be having nightmares. . . .

Meaning and metaphor

Laura Collins over at Eating With Your Anorexic posted an interesting entry today, on a topic that's close to both my heart and my obsessions. Writing about our tendency to ascribe meaning to experience after the fact, she points out some of the "meanings" that have been ascribed to eating disorders over the centuries, from piety to family pathology to cultural norms around thinness. Her point is that eating disorders neither represent nor are caused by any of these hindsight insights, and simply are biological diseases.

It's a point I can agree with. Only I find that I keep wanting to add, "But there's more!"

As a poet and a journalist, I know both sides of the dichotomy. I've written here about growing up with panic disorder, and have alluded to the levels of meaning I assigned to my anxiety over the years. I've been through more than my share of therapy for anxiety, and have often gained insight from dreams, journaling, and exploring the metaphors and allusions that come with this disorder. Writing for me became a redemptive act very early on. Even in my teens I was aware that I wanted to make meaning out of suffering. If an important poem grew out of many nights of insomnia and philosophy, existential terror and affliction, well, maybe it was all worth it. And if not, I'd still created something beautiful—or at least meaningful—out of my pain. I'd made something out of, well, not nothing, but nothing useful.

The journalist part of me understands the concepts of neurotransmitters, genetics, and brain chemistry. I've had ample evidence of my panic disorder as a biological disease, often triggered by hormonal shifts and other physiological upheavals.

But. Still. I don't think that makes the poems, the metaphors, or the insights less important or meaningful. In fact they are deeply meaningful to me and, I hope, to others.

But. Still. Years of insight-based therapy have not changed the panic attacks or anxiety in any appreciable way.

So what does it all mean? Is retrospective insight always a chimera? Should we discount it altogether and stick to the facts, ma'am, just the facts?

I think when it comes to treatments for eating disorders and other psychiatric illnesses, the answer is yes. If I dream, as I once did, that my grandmother is trying to pierce my ears with a blunt knitting needle, and causing a lot of pain in the process, I don't believe this is a clue to the roots of my panic attacks.

But I'd hate to give up the relentless and quintessentially human quest for meaning and metaphor. That's the fertile terrain of all art and much spiritual and emotional growth.

All of which is a very long-winded way to say that I think what's needed here is a separation of church and state. When it comes to causes and treatments of eating disorders and other illnesses, I'm with the scientists; give me DNA and anatomy and chemistry. But when it comes to being alive and human, I need meaning and mystery and the indirect but often achingly apt language of symbol and metaphor. We need it.

And another Leaden Fork award goes to

all the folks involved with this incredibly tasteless book.


How to Get Fat is one of a series of so-called "self hurt" books. We know they're supposed to be funny because of the Dick-and-Jane-style illustrations. Other titles in the series include How to Get Into Debt, How to Drive Like a Maniac, and How to Traumatize Your Children. Now there's a knee-slapper. They're all published by an outfit called Knock Knock, which describes itself this way:

We are Knock Knock, a semi-spanking-new design company with aspirations to greatness. We concoct, manufacture, and distribute witty objects of cosmopolitan panache. . . . Our customers comprise the impish, the dapper, the droll, the young-at-heart—those who feel misunderstood by Santa-inflected wrapping paper and maudlin gilded greeting-card sentiments that rhyme. . . . Knock Knock seeks to integrate art and commerce—creating original, authentic, noncynical products that support themselves in the marketplace so that we don’t have to deal with “clients.”. . . Rather than a product category, material, or target market, Knock Knock’s unifying force is a sensibility. Also, we read a lot.

I'm all for poking fun at ourselves, but this one just doesn't seem funny. The humor here derives from the usual assumption that being thin is a choice and that any idiot would certainly choose it. It's really nothing more than a po-mo diet book.

Should you feel like weighing in on this book, you can contact the publisher at info@knockknock.biz or call (800) 656-5662.

Passing the Roar

A couple of days ago, writer/blogger Lisa Romeo gave me a "roar" (thanks, Lisa!) with a directive to do two things: list three things I think are crucial to powerful writing, and "roar" at a few of my favorite and fearless writers.

My three requirements for powerful writing:
Move the story forward. Good writing, like life, doesn't stay still. It's gotta move. Don't linger. Keep going.

Less is more. I'm a poet, so I learned early on that shorter is almost always better--punchier, sharper, more vivid. Compress, compress, compress.

Sound and fury. Powerful writing lives in the ear as well as on the page. Read it out loud to yourself. The sound of the words carries part of the meaning and effect.

Now, on to the roaring part. I'm going to tag a few bloggers, since this is, after all, a blog.

Kate Harding. Kate's blog, Shapely Prose, wins the I-wish-I'd-written-that award. Kate's prose is lucid, compelling, and as much fun to read as it is to write. She's a fat activist, feminista, and all-around fascinating writer. Fearless? Ya mon. Go read her. You won't be sorry.

Sandy Szwarc. Sandy's blog, Junkfood Science, takes on all manner of sacred cows, from Big Pharma to Big Science and more. If you've ever read a news article that scared you--"Obesity is contagious," for instance--check it out on Sandy's site. She's blown open a lot of b.s.

Rachel over at The F Word. It's the internet age, so I don't even know Rachel's last name. But I do know that her trifecta of obsessions--food, fat, and feminism--makes for some powerful writing. We don't always agree, but I'm always interested in what Rachel has to say.

Laura Collins. The author of Eating With your Anorexic is one of the feistiest writers/activists I know. Her book, and her online parent forum, have saved many lives. She's not afraid to take on the powers that be.

Caroline Leavitt. One of the best essayists I know. And I'm not just saying that because she's got pieces in both my first and second anthologies, either. Caroline has a gift for writing personal narratives that hit home for others.

I could probably keep going. Maybe I'll do installment 2 tomorrow.

Keep Santa fat and feed the hungry

I have a feeling I've come to this story late here in the fatosphere . . . but no matter. Better late than never. Thanks to littlem for sending me the link to this awesome site.

Sign the petition there to Keep Santa Fat, and the keepers of the site will donate a pound of food to America's Second Harvest.

While you're at it, make your own donation. I hate to think of anyone going hungry, at this time of year or any other.

Et tu, Santa?

I don't know about you, but I'd like to take this guy's red suit away.

He's a Scottish dime store Santa who refuses to pad his middle with a pillow because he thinks it makes children think it's OK to be overweight.

No, indeed. We wouldn't want the little children to grow up loving their bodies or anything.

I say we vote him off the island.