Why I don't fast on Yom Kippur

Millions of Jews around the world are fasting today, in observance of Yom Kippur. From sundown last night to sundown this evening, they will drink and eat nothing, in honor of the most sacred day of the Jewish calendar: the day your fate is sealed in the book of life for the coming year.

I am not fasting this year, or next year, or any other year. Not because I'm too gluttonous to give up food and drink for 24 hours. Not because I think it's irrelevant.

I'm not fasting because of what it means to be to be hungry, to be fed, and to be strong.

Let me tell you a story: My first Yom Kippur fast happened the year I turned 13--an adult for the purposes of Jewish law. I wanted to fast. I wanted to behave like an adult. I wanted to look pale and weak, to feel my stomach cave in toward my spine, to do my duty and sacrifice for the sake of holiness.

(If this sounds like the rhetoric of anorexia, well, keep reading.)

I made it through the night, the next morning, the next afternoon. Through hours of services, singing, breast-beating, and sermons. I was strong. I was proud. I was adult.

I was also very, very hungry.

In our house then, food was a kind of emotional currency. Food could be love or punishment; withholding of food could constitute either extreme. My mother was always dieting, which means that we ate, but always with the sense that we weren't really supposed to. The less you ate the better. Appetite was a bodily function that made you weak, and gluttonous, and fat. Appetite was to be squelched at every opportunity.

By 5 o'clock that Yom Kippur afternoon, I felt like I would faint if I didn't eat something. Anything. I left services and went around back, to the synagogue's playground (it was also an elementary school). I sat on the swing, went down the slide in my fancy new dress, and dug idly in the sandbox.

And that's where I found it: a half-eaten Milky Way bar. Someone had taken a few bites and then tossed it, wrapper and all, into the sandbox. It was food. It was my favorite candy bar. It was covered in sand and looked better than any food ever had to me.

I peeled the wrapper and took a bite of the uneaten side. I took another, and another, and soon had eaten the whole thing, sand and all. I felt guilty and ashamed. I was weak. I was unworthy.

I was also, later that night, sick as a dog, throwing up the candy bar and the break-the-fast meal we ate a few hours later. Retching and miserable, I had plenty of time to connect the dots: I had sinned, and I was being punished. Violently. Virulently. Righteously.

Fast-forward 35 years or so, to a night when my daughter Kitty was lying in the ICU, dying from anorexia. She was dying because she would not, could not eat. It took every ounce of determination and grief my husband and I had to help her start down the road to recovery.

That's when I connected the new set of dots: Not eating could kill you. Being hungry held no virtue. In the ultimate appetite sweepstakes, being hungry was the booby prize. You thought it was the goal, but really it was the punishment.

There have been plenty of times in my life since that Yom Kippur long ago when I have been hungry. But in the intervening years I've learned to honor my appetites--for food, for love, for compassion, for connection. This learning has changed my life.

And that's why I'll never again deliberately starve myself, for a day or for a month. There's far more virtue in learning to live with appetite and hunger than in shutting it down.

"You look great! Have you lost weight?"

I went "home" for the weekend last week--back to Madison, where I lived for 16 years. It was great to see old friends, neighbors, acquaintances, etc., and very emotional, too. It takes time, lots of time, to forge friendships. This year is rather a lonely year in Syracuse.

It was great to see those friends, but I really wish so many of them hadn't commented on my weight. The consensus seemed to be that I was looking better than usual so I must have lost weight. This conflation really, really bugs me. Why is a weight loss always associated with looking good?

I went to the doctor today and got on the scale for the first time in probably 6 months. Yes, I have lost a couple of pounds, but not, as one friend suggested, "a ton of weight!" For someone my size--five foot one and a little, 161 pounds--a couple of pounds makes little visible difference.

"You look good because you're happy," my husband pointed out. That's right. I'm engaged and invigorated by my new work and by the challenges and curiosities of making a home in a new place, and it shows.

I look forward to a day when looking good and losing weight are two separate and distinct ideas. And when we think twice before mentioning them in the same breath.

Celebrity weight watchers

I won't be the first person to rant about the intense media attention we pay to celebrities' weights, and I won't be the last. But this little video really bugged me almost as much as the scene in the Sex and the City movie where Samantha (Kim Cattrall) has gained 10 pounds, and the rest of the characters act like she should put on a burqa and have her jaws wired shut.

In this case, the video suggests that actress Demi Moore has gained 15 pounds. "Is there more of Demi to love?" croons the voiceover. The tone of voice makes it clear that this would not be a good thing.

I pity any woman (or man, for that matter) who is subjected to this kind of scrutiny. It feels to me like a form of externalized self-loathing--things we wouldn't dream of saying to or about an ordinary person may be said about a celeb because, hey, she's fair game.

We learn, from the culture that produces such relentless trash, to say these things to ourselves, about ourselves. Videos like this feed the nasty little voice that lives in our heads, telling us you're fat, you're ugly, you're old, you're worthless. For some of us, this voice can become deafening. For some, it stays relatively quiet.

But you know what? Even a whisper of this is too much.

Harvard bucks the mainstream on "nutrition information"

Last year, if you ate at a Harvard dining hall, you were confronted by a large sign listing the calorie, fat, protein, etc. content of everything you ate.

This year the signs are gone, thanks to a group of parents who protested them.

"The feeling was that for people who have eating disorders or who struggle with issues around the literal value of food, the emphasis on nutrition information does not always lead people to eat in a healthy manner," said Harvard dining hall spokeswoman Crista Martin.

It's naive of anyone to think that an "emphasis on nutrition information" will lead to "healthier" eating decisions. Most of us can't help but be aware of fat grams, calories, etc. in the food we eat (or don't eat), and the effect is hardly salutory.

I practice intuitive eating most of the time. I gave up dieting years ago. I parented a child through anorexia. But when I'm faced with those "nutrition information" signs, I immediately feel that whatever I'm eating, or about to eat, is too much. I immediately slip back into a mindset of any calories are too many.

It's like the story about the old miser and his horse. Each day the miser fed his horse a little less, until finally the horse died of starvation. The miser's comment: "Just when I was training him to need no food at all!"

Those calorie count listings make me feel as though the goal is to eat as little as possible--ideally, nothing. They immediately trigger fear, anxiety, and the restricting mindset.

Luckily I am too ornery to stay in that mindset for long. But is it really a surprise that for students at Harvard, one of the most competitive schools on the planet, signs listing calorie counts of everything served in the dining halls might be a bad idea? That a vulnerable population (driven, intensely competitive Harvard students) might be triggered by these reminders of "healthy eating"?

I don't think so.

I only wish the rest of the world would follow Harvard's lead on this one.

Free bulimia treatment

A research team at University of North Carolina, led by the fabulous Cindy Bulik, is looking for people with bulimia to take part in a pioneering study on treating this disease.

The study takes place at two sites: UNC, in Chapel Hill, and University of Pittsburgh. But you may not have to live in either of those places to enroll in the study, because half the study participants will be randomized to what researchers are calling CBT4BN, a web-based treatment involving weekly on-line chats with therapists and other distance elements.

The idea is to get treatment to people who may not have access to a therapist trained in cognitive behavioral therapy (CBT), which is currently the gold standard of treatment for adults with bulimia. The Maudsley approach has shown great promise for adolescents with bulimia.

Eating disorders are terrible, life-sucking diseases, and their treatment is still largely mysterious. Studies like this one are literally a lifeline to people struggling with EDs. So thank you Cindy, and the rest of the team, for doing this crucial work. Those of us who have seen people we love come suffer with an ED are very grateful.

Fighting weight discrimination, one doctor at a time

If you've ever had the experience of going to a doctor for an earache and being lectured on your weight--or even if you haven't had that experience but dread it--there's hope for America's doctors. Yale University's Rudd Center has created an online course to help sensitize docs to weight discrimination in themselves and in the health-care system. According to a spokesperson, the course is also designed to help docs develop strategies to serve their patients better--always a good thing.

Doctors get 1 credit of continuing ed for doing the course, and their patients get a doctor who's at least been exposed to the notion of fat acceptance and questioning the status quo on weight.

I looked at the first few frames of the course and have to say it looks pretty cool. Check it out. Better yet, get your doctor to check it out.

Fighting Stigma with Science

This video is required watching for anyone with an interest in eating disorders. Cynthia Bulik is one of the leading researchers in the field, and this interview, done by Jane Cawley, co-chair of Maudsley Parents, is compelling and important. Take a look.


Fighting Stigma with Science from Jane Cawley on Vimeo.

Eat to enjoy, not to lose weight

This article in the New York Times may seem a bit redundant to some, but I'm encouraged to see it in the venerable Gray Lady herself. It saddens me a bit that the notion of eating for pleasure rather than weight loss is such a novelty, but there it is. At least it's out there.

David Foster Wallace, 1962-2008

My closest encounter with the writer David Foster Wallace, who committed suicide last week, came when I was working as an assistant in a small literary agency. One of my jobs was to read the slush pile, the manuscripts sent in cold by hopeful writers looking for an an agent. One of the manuscripts that came across my desk was a draft of what later became Wallace's first published book, The Broom of the System. It was brilliant, entertaining, dazzling, and I wanted to take Wallace on as a client. My boss said no. "He'll never be a commercial writer," he said scornfully, and that was that.

He was wrong, of course, about that and many other things. Wallace went on to become not only critically acclaimed but to achieve some measure of commercial success. He was an original, one-of-a-kind, a writer of immense talent and heart. From the oustide, his life looked golden in every way.

He was also, we know now, severely depressed for much of his life. His struggle with depression came to an end last week when he committed suicide. And therein lies my point. It is impossible to know, from the outside, what anyone else's interior life is really like. That works both ways: The perfect-looking life may be a living hell, and the seemingly diminished life may be rich and full in ways outsiders can't imagine.

I bring this up not only because I'm mourning a writer of grace and heart; I bring it up in this blog because eating disorders, like depression, often present a golden exterior. The life of someone with an ED can look wonderful, perfect, fulfilling to an observer. Yet the person who struggles, every day, every minute, with anorexia or bulimia or ED-NOS, may be smiling through torment.

When I read about Wallace's death, I couldn't help thinking about how many people with anorexia wind up committing suicide as well. And I mourn them too--the lives that could have, should have gone a different way.

I mourn the misfire of chemicals in the brain that causes severe depression, anxiety, eating disorders. And I look forward to the day when we will know more and be able to help more.

In the meantime, go out and read one of Wallace's works, and remember this talented and tormented man.

No evidence-based treatment for anorexia?

According to this study, which is an overview of 40 years of eating disorders treatments, there are still no evidence-based treatments for anorexia nervosa. "A specific form of family therapy (based on the Maudsley model) appears promising," write the study's authors.

Appears promising? Actually, FBT, or the Maudsley approach, has been shown to be successful (85 to 90 percent long-term recovery rates) for treating both anorexia and bulimia. In the last 10 years there have been several good studies on FBT, including this one, this one, and this one.

And yet some of the top researchers in the field are still saying that there is no evidence-based treatment for anorexia, and that the Maudsley approach "appears promising." Which is rather like saying that there appears to be a link between smoking and lung cancer.

After 40 years with no other good treatments, you'd think researchers would jump on this one. So why the damning with faint praise?

Come on, you guys. You're the ones who can get the word out to parents best. You have a moral obligation to spread the word about FBT--the ONLY evidence-based treatment we've got at the moment for treating anorexia. I'll be thrilled if we turn up more treatments that are effective. In the meantime, though, let's use what we've got.

Take a survey, help eating-related research

The invitation below comes from a graduate student at the University of Maryland. Please correspond directly with her if you have questions. Take the survey and help add to what we know about eating.

--HB

TO ALL WHO WROTE IN: The link has been fixed now. Thanks for letting me know!

TAKE A SURVEY

Do you love food? Can you often “out-eat” most of your friends? If the answer to either of these questions is “yes,” you may be a great candidate to take my survey.

My name is Colleen Schreyer, and I am a grad student at the University of Maryland, Baltimore County. I am doing my master’s thesis on individuals who are able to eat a lot of food, and genuinely enjoy eating. I am also looking at individuals who are able to eat a lot of food, and perhaps don’t feel so good about it. I have an online survey that takes approximately 30 minutes to complete. All participants are entered in a drawing to win an Apple Ipod. Your answers are completely confidential, and I have approval from my university to conduct this research. If you would be willing to check out the survey, please click on thIS link. All and any help is greatly appreciated. If you have any questions, please email me- colleen2@umbc.edu. Thanks so much for your time!

An open letter to all diet food peddlers

Due to the recent avalanche of PR-type emails to my inbox, I feel compelled to write this letter.

If you do PR for a diet-related product, please do not send me emails offering to send me samples and hoping I'll review it on my blog.

Don't send me perky emails about 100-calorie foods that will fill you up all day, packed full of unparalleled nutrients. (Really! Who dreams this crap up?) Don't think I'll shill for you. I won't. If I write about your diet product, rest assured I will tear it apart. That kind of publicity you really don't want.

This blog is NOT diet friendly. To paraphrase my late friend Mimi Orner, we are anti-diet, anti-anorexia, anti-bulimia, anti-healthy eating fascism, and anti-eating disorder here. I am not your friend. My readers are not your potential customers.

This blog is a diet-free zone. Go peddle your crap somewhere else.

Support group for parents: Madison, Wisconsin

The next meeting of the Madison, Wisconsin, parent support group will take place on Tuesday, Sept. 23, at 7:30 p.m. at Starbucks, 3515 University Avenue. This group is parent run and offers support, practical advice, encouragement, and hope for parents whose children are struggling with eating disorders, with a special emphasis on Family-Based Treatment (also known as the Maudsley approach).

For more information, contact Denise Reimer, reimer1@charter.net.

And if you'd like me to post a parent support group in your area, please email me off the blog at hnbrown at tee dee ess dot net.

Naturally fat?

This comment, made in response to an earlier post, seems to epitomize so much of the anti-obesity attitude that I thought it deserved its own post:

Of course there's nothing wrong with being fat. I don't get why fat people get offended when we say that obesity is dangerous. We're not talking about people who are fat. We're talking about people who are dangerously obese. You remind me of the naturally skinny girls who get offended when people speak out against anorexia nervosa and complain, "Why does everyone hate skinny people? Wah!"

There is absolutely nothing wrong with being naturally fat or naturally skinny. But if someone is deathly thin or morbidly obese then it is a real problem.

So first of all, please tell us how to distinguish between "naturally fat" and "morbidly obese." What is "naturally fat"? Is it the-amount-of-fat-I would-have-had-if-I'd-never-gone-on-a-diet? Is it 5 pounds "overweight"? 20? 50? Is it the same for you as it is for me? Is it fat that comes from eating avocados and almonds as opposed to chocolate cake and ice cream? Who decides what constitutes natural fat vs. unnatural fat?

I'm fascinated by the semantics around this issue. Morbidly obese = morbidity = a death sentence if you're fat. When's the last time you heard anyone called "morbidly skinny"? And yet semi-starvation can certainly kill you.

Personally I don't know any "naturally skinny girls who get offended when people speak out against anorexia nervosa." Someone who is thin but not eating disordered typically wouldn't be offended by this. Someone who's eating disordered, either diagnosed or subclinically, might well be offended because the nature of anorexia is to be ego-syntonic. They identify the illness with themselves and will defend it to the death--their own. They can't help it; it's a symptom of the disease.

I hope my readers will weigh in (so to speak) on this one. I'd like to know what you think.

Fat-free picnic

My younger daughter and I just came from an all-school picnic at her new school. She's starting 8th grade on Monday. The picnic was massive--800 people milling around the school grounds on a humid, muggy night. It wasn't the kind of event where you meet and really get to talk to people, and that was OK.

What wasn't OK was the food. Oh, it tasted all right, but I noticed there was nary a speck of fat or sugar at the picnic. There were flame-grilled veggie burgers, grilled chicken breasts, and I believe some kind of hot dog (I don't eat meat, so I didn't notice). There was pasta salad in a vinaigrette that was all vinegar. There were grilled veggies, which were very tasty. There was a huge bowl of salad with an array of dressings, every one of which was fat-free. I asked one of the caterers if there was any salad dressing with oil in it, and she said, "Honey, they specifically told us to bring only fat-free dressings."

For dessert there were trays of watermelon, which happens to be the one fruit I dislike.

I just hope this isn't a sign of things to come.

Are you a woman in your 20s or 30s? Read this

This opinion piece is not on the topic of food or eating, but this is a crucial and compelling subject, and one that every woman (and man) in America today should read. Especially those of you who think feminism was what your parents and grandparents did, and you're the new post-feminist generation. :-) There is still work to be done, my friends.

Suffer the little children

The latest "SmartSummary" from our much-hated health insurer arrived in the mail yesterday. I'm sure one reason our premiums are so high is that they periodically generate an 8-page booklet for each member of the family, replete with all sorts of useless information.

The piece that really burned my boat was this page, which arrived only with my 8th-grader's package. Let's take a minute to deconstruct this noxious document, shall we?

First, take note of the underlying threatening tone of the introduction. In case you can't read the scan, here it is:

Before you go back to school, take a minute to think about how sitting in class means you'll need more time for physical activity outside of school to stay healthy. Use this Body Mass Index (BMI) to figure out if you're in a healthy weight range, then you can see how to burn more calories and eat healthier in a way that fits your lifestyle.

Ths little gem offends on a variety of criteria, starting with the grammatical and syntactical errors (comma splice, word repetition, and excess verbiage). It then moves on to emotinal blackmail. Sitting in class leads to not staying healthy, unless you add more physical activity. There's a not-so-implicit threat here: You've got to burn off every minute you spend sitting on your tush and studying, kids.

For a kid like my older daughter, who likes to play by the rules and do everything "right," this notion could be enough to trigger a lifelong eating disorder, not to mention a fear of school and studying. And who's to say that each kid isn't already plenty physically active? The summary assumes that kids aren't getting enough exercise. Maybe they are, maybe they aren't. But this piece of paper sure as hell doesn't know.

Moving down the page, notice the list titled "Burn the Calories." One of the most egregious ideas behind the whole "wellness" movement is the idea that you can quantify and generalize in this way. Whereas anyone with a whiff of education on the subject knows that this depends not only on the size and age of the person in question but on his/her particular metabolism. Yet this paper confidently announces that a half hour of soccer burns 238 calories. Bullshit.

The eating disorder triggers continue on the bottom left of the page, where my daughter is told that 1 small cheeseburger would take 29 minutes of jogging to "burn off." There's a lot wrong here, starting with the idea that every bite you take must be "burned off." That's like saying every gallon gas you put into your car must be used immediately. Then there's the implicit idea that the foods listed here--plain "donut" (sic), cheeseburger, piece of pie, fried chicken sandwich--are bad for you and must be routed from your system asap.

Finally there's the ubiquitous BMI calculator and BMI chart. Once more with feeling: The idea of "ranges" is beside the point, especially for growing children. What's healthy for one child at one point in her life will not be the same as what's healthy for another child, or for the same child six months later.

I call this Bullshit 101. And I'm ever so glad my hard-earned money will no longer be going toward creating such appalling crap.

Off-topic: Need a laugh?

These came to me from my dear husband, who got them another blog, and I just couldn't resist.

Here are the top nine comments made by NBC sports commentators so far during the Summer Olympics that they would like to take back:

1. Weightlifting commentator: 'This is Gregorieva from Bulgaria. I saw her snatch this morning during her warm up and it was amazing.'
2. Dressage commentator: 'This is really a lovely horse and I speak from personal experience since I once mounted her mother.'
3. Paul Hamm, gymnast: 'I owe a lot to my parents, especially my mother and father.'
4. Boxing analyst: 'Sure there have been injuries, and even some deaths in boxing, but none of them really that serious.'
5. Softball announcer: 'If history repeats itself, I should think we can expect the same thing again.'
6. Basketball analyst: 'He dribbles a lot and the opposition doesn't like it. In fact you can see it all over their faces.'
7. At the rowing medal ceremony: 'Ah, isn't that nice, the wife of the IOC president is hugging the cox of the British crew.'
8. Soccer commentator: 'Julian Dicks is everywhere. It's like they've got eleven Dicks on the field.'
9. Tennis commentator: 'One of the reasons Andy is playing so well is that, before the final round, his wife takes out his balls and kisses them... Oh my God, what have I just said?'

It stands to reason

that if your knees have deteriorated enough to limit your mobility, you are less able to exercise. But that little piece of common sense hasn't stopped the British health care system, which refuses knee replacements to Britons who are considered "clinically obese"--with BMIs of over 30.

Now a study from the University of Southampton demonstrates that yes, Virginia, fat people benefit from knee replacements, too.

Just for a little context: My BMI is 30.9. I am a physically active person who bikes or walks to work (3 miles), runs up stairs, bikes 8 or 10 miles for fun, and loves to go dancing. If I needed a new knee, I would be one pissed-off person if I was told I was too fat to get one.

For once, common sense may prevail. Though let's see if the NHS changes its policies before we celebrate.

Join the fray . . .

over at BusinessWeek, where there's a somewhat spurious debate going on over whether the media causes eating disorders. Normally I try to stay away from arguments like this, but because it's BusinessWeek, a fairly respectable publication, I think it's worth it to put the point across. Be warned: There are some real trolls commenting over there, so don't visit if you're feeling fragile.

We're getting there. . . .

And I know this from reading pieces like this in the New York Times. Turns out your performance on a treadmill test is a far better measure of your mortality risks than the numbers on a scale. We told you so!

So yes, it's better to be fat and fit than skinny and unfit. And yes, let's take a look at just how loaded words like fat and overweight are in our culture.

I can't wait for this kind of thinking to percolate down through the culture. Just last night I was at dinner with, among others, a woman who teaches others about exercise and fitness. She paid lip service to some of the "fat but fit" thinking, but her parting comment was so typical of this debate: "But it's still bad to be fat."

I'm sending her the link to this article. Hope she gets it.

Book review: Why She Feels Fat

If you pick up Why She Feels Fat, by Johanna Marie McShane and Tony Paulson, because you want to understand the inner life of someone with anorexia, bulimia, or binge eating disorder, you'll be sadly disappointed. Actually I think you'll be disappointed no matter why you pick it up. There are dozens of books exactly like this already in print. The world certainly doesn’t need another one.

I expected to read an insightful exploration into the biology and psychology of eating disorders. I expected to find an answer to the question posed by the title. Why do people with anorexia and bulimia feel fat even when they’re not? The phenomenon has been well documented; Walt Kaye tells the story of bringing two 70-pound anorexic women into a class of med students and asking them to describe each other. Each sees the other as way too thin, gaunt and unattractive. Each sees herself as way too fat. This is a fascinating demonstration of distorted brain chemistry at work.

But these aren’t the kinds of questions the authors take on. Their answers to the question posed in the title are the same old same old we’ve been hearing for many years now about eating disorders: She feels fat because she was sexually abused, because her parents divorced, because her mother is overly critical and her father is absent. She starves, binges, and/or purges because—wait for this groundbreaking revelation—it’s a way to control a disappointing or painful world.

There's nothing about biology, genetics, or any of the new research on eating disorders that is changing the way we understand and treat them.

There's nothing new about the so-called insights offered by this book: They're all the rationalizations and delusions of eating disorders, offered up without analysis or true understanding. When my daughter was ill with anorexia, I heard them all. The difference is that I didn't take them at face value. These authors appear to do just that.

The section on treatment is just as outdated and even harmful. "The job of the therapist is to help your loved one understand, acknowledge, and resolve the issues that are fueling her illness," write the authors. In the meantime, if your loved one starves to death, or has a heart attack, well, never mind. At least they'll get to the bottom of the problem.

The job of the therapist is not to answer the question why. It's to heal the eating disorder.

If the authors were up on the latest research on treating eating disorders, they wouldn't write, as they do, "Medication may be necessary either for the short term to facilitate treatment or for the long run to achieve emotional balance." While there are n o doubt people for whom medication is helpful, none of the big studies have shown any reason for routinely prescribing meds like Prozac and Paxil for those with eating disorders. This is not only wrong-headed advice--it's one size fits all advice.

The authors also recommend working with a dietitian or nutritionist--again, standard advice for someone with an e.d. They continue down the conventional path by recommending that the nutritionist and patient develop an eating plan together. This might be good advice for treating bulimia, but it's definitely not good advice for treating anorexia. And that's another of the problems with this book: The authors don't differentiate among the eating disorders.

I could go on, but you get the idea. No stars for this book.

Eating disorders workshops in central New York

The Mental Health Association of Onondaga County is offering a two-part Parent Partner Workshop, held on September 9 and 16th in Syracuse, NY. These three-hour workshops are designed to help families and loved ones support people with eating disorders, and I hope if you're in central NY you'll try to make one of the workshops. I'm thrilled that I've been asked to speak on the 16th. If you attend, please come say hello. I'll be talking about our family's experience with anorexia and about Maudsley Parents.

And the best part is that snacks are provided!

Details:
Sept. 9 & 16
6-9 p.m.
Cornell Cooperative Extension, 220 Herald Place, 2nd Floor, Syracuse
$10.00 per person, $30.00 for family of 4

Follow-up on A.

I emailed A. and heard back from her--a great email. She knows exactly what she's dealing with, with our family, and seems to have a pretty good handle on it.

And it seems that we can develop a relationship. I'm very glad.

Eating disorder studies

Hello all,

Here's your periodic roundup of research opportunities available in the e.d. world. We all know there is woefully little research on e.d.s--here's your chance to help make a difference. And maybe get some top-of-the-line free treatment.

Research Studies on Eating Disorders:

Clinics and Hospitals Team up to Study Eating Disorders: Six North American sites are teaming up to evaluate outpatient treatments for adolescents with anorexia nervosa. To date, this is the largest National Institute of Mental Health-funded anorexia nervosa treatment study. The study will allow for a thorough evaluation of two types of family therapy and will also test whether FDA approved antidepressant medication can enhance and prolong the result. The goal of the study is to improve recovery rates.

"Males and females ages 12 through 18 are the target population, because it is essential to identify and treat the illness in its early stage," says Craig Johnson, Ph.D., director and founder of Laureate Eating Disorders Program. He says that a parent may suspect anorexia nervosa if they have an underweight child that worries about their weight and appears to avoid food obsessively. Dr. Johnson and Ovidio Bermudez, M.D., internationally known eating disorder experts, are the principal investigators at Laureate for this study of two forms of outpatient family therapy. The treatments prescribed in the study, have been tested and shown to be helpful with patients in previous studies at Stanford University School of Medicine and The University of Chicago Hospitals.

After undergoing a screening process, families who qualify will be randomly assigned to one of four treatment combinations. The study is comprised of 16 one-hour family therapy sessions delivered over a nine-month time period and a medication (either fluoxetine or placebo) delivered over 15 months under close medical supervision. The family therapy sessions, medications and medication monitoring are all paid for by the NIMH grant.

This international eating disorders study is being coordinated by Stanford University, and includes six recruitment sites: University of California San Diego, Washington University School of Medicine in Saint Louis, Cornell Medical College, Toronto General Hospital, Sheppard Pratt Health System in Baltimore and Laureate Psychiatric Clinic and Hospital.

Individuals who suspect they might have anorexia nervosa, family members who believe their child may have the illness and physicians of potential patients are urged to call Nancy Morales, RN at 918-491-3722 to learn more about the study and/or apply for participation.



San Diego, CA: UCSD Researchers Seek Males and Females with Anorexia Nervosa: The UCSD researchers are currently seeking adolescents and adults currently suffering from Anorexia Nervosa to participate in one of their three current studies. To qualify for any of the studies one must be at least 15% below ideal body weight and be fearful of weight gain, despite being underweight. Both adults and adolescents between the ages of 14-45 are needed to participate in a taste study and would be compensated for up to $70 for completing the assessments, taste tests and interview. Adults 18 years of age and older are needed to participate in a randomized control trial of the medication Quetiapine, in which they will receive either the study medication or a placebo. Subjects will be compensated up to $360 for completing study related assessments and the medication treatment. In addition, they are offering several months of family therapy treatment for families with adolescents between the ages of 12 and 18 at no cost. The adolescents in this study will also be randomly assigned to receive either the medication Fluoxetine or a placebo. For more information, contact UCSD Eating Disorder Treatment and Research Program at 858-366-2525 or email edresearch@ucsd.edu.



San Diego, CA: UCSD Researchers Seek Women Recovered From an Eating Disorder: Help UCSD researchers understand what causes eating disorders. They are seeking female participants between 18 and 45 years of age who are recovered from Anorexia or Bulimia Nervosa. By participating in the study, subjects will be assisting physicians and researchers in developing new treatments for these complex and serious disorders. Subjects will be compensated for your participation in this study. For more information contact the UCSD Eating Disorder Research and Treatment Program at 858-366-2525 or email edresearch@ucsd.edu.



Massachusetts Research Study - Massachusetts General Hospital Study of Therapy for Bone Loss in Anorexia Nervosa: The Neuroendocrine Unit of Massachusetts General Hospital is conducting research studies on anorexia-induced bone loss. Their screening study is for men and women age 12-50 with anorexia nervosa. They are investigating causes of osteopenia (or bone loss) in the spine, hip, wrist and total body. The study involves one visit of approximately 3 hours. Their treatment study is for women aged 18-45 with anorexia nervosa and absent or irregular menstrual periods. They are investigating the combined use of a natural hormone and a medication that is effective for bone loss in postmenopausal women as a novel treatment for the bone loss seen in women with anorexia nervosa. They hope that the combination of these two investigational medications will help rebuild depleted bone and prevent further bone breakdown in women with anorexia nervosa. The study consists of 6 visits over 12 months. A stipend of up to $675 is awarded throughout the course of the study. If interested, call Erinne Meenaghan, N.P. at 617-724-7393 or email nedresearchstudies@partners.org.



Massachusetts: Bulimia Nervosa Study: Free confidential treatment is available to those who are eligible. Do you or someone you know binge eat? Do you or someone you know compensate by vomiting or other extremes? Do you or someone you know have severe moodiness or relationship problems? Researchers are now enrolling participants (ages 18-65) in a free treatment study investigating two active treatments, including education and counseling, for bulimia nervosa. If interested call 617-353-9610 or visit here.



New York, NY: NIMH-funded, IRB-Approved Study of Adolescents with Bulimia Nervosa (ages 12 - 21 years). This study takes place at NYSPI/Columbia University and compensation is provided for participation ($100). For more information, contact Laura Berner at 212-543-5316. P.I.: Rachel Marsh, Ph.D., Assistant Professor of Clinical Psychology, Columbia University/ New York State Psychiatric Institute, phone 212-543-5384, email marshr@childpsych.columbia.edu.



New York, NY: The National Institute of Mental Health is sponsoring a multi-center international study to compare two types of family therapy as well as fluoxetine or placebo (an inactive medication) in the treatment of adolescents with anorexia nervosa. They are looking for families with an adolescent with anorexia nervosa between the ages of 12-18 years. Participation involves completing assessment interviews, questionnaires, and engaging in 16 family therapy sessions over the course of nine months with medication continuing for another six months. The study is being held at the Eating Disorders Research Program, The Westchester Division of New York-Presbyterian Hospital, Weill Medical College of Cornell University. Contact the Research Coordinator, Samantha Berthod, MA at 914-997-4395.



Pittsburgh PA. Seeking Women Recovered from Anorexia or Bulimia Nervosa. Dr. Walter Kaye and his research team at the Eating Disorders Research Program at the University Pittsburgh Medical Center are looking for women who have recovered from anorexia or bulimia nervosa for a research study on brain chemistry in eating disorders. Study participants must be between 18 and 45 years old, medication free (birth control pills acceptable) and not pregnant or nursing. The study involves phone interviews, questionnaires, PET and MRI scans, lab work, physical exam, two visits to Pittsburgh and 8 weeks of fluoxetine (generic form of Prozac). (Note: All expenses incurred during the study, e.g. travel expenses, lab work, physical exam and etc. are paid for by the study.) In addition, eligible participants will be compensated up to $1300 upon completion of the study. For more information, email EDResearch@upmc.edu or Dr. Kathy Plotnicov at plotnicovkh@upmc.edu or Dr. Sharon Barnes at barnessd@upmc.edu. Interested parties can also call toll-free at 1-866-265-9289 or submit a contact form online here.

"She's as big as a house!"

I spent last weekend at a reunion of my extended family. I've spent very little time with my family over the last 20 years. Many of my aunts, uncles, and cousins still live in the same little square of suburban south Jersey where I grew up. I moved away at 16 and never lived in the vicinity again.

And since my grandparents died--my grandmother 18 years ago, my grandfather 5 years ago--I haven't seen the extended family very often. We get together at funerals and weddings, and that's about it. Last weekend my aunt and a cousin planned a reunion of the very large extended family, so it was the first time in a while I saw many of the relatives I grew up with.

For the most part the weekend was wonderful--except for the fat talk. I knew there would be fat talk; there always is, with my family, most of whom are not fat, all of whom are very conscious about fat.

Among other things we created an epidemiological chart showing diseases in the family. Everyone was encouraged to list those that affected them. I wrote "eating disorders" and "anxiety" on the chart. My cousin L. happened to be standing nearby when I'd finished. L. has been fat for much of her life--anywhere from 20 to 120 pounds overweight. She's extremely judgmental about weight (most of all of her own, of course) and brings up the subject often.

L. has two daughters, both grown now. One of her daughters had bulimia as a teenager, or so I thought. I've always liked my cousin A. a lot, and was sorry she wasn't at the reunion. I turned to cousin L and asked, "A. had bulimia, right? How's she doing now?" (Cousin L. knows about my daughter Kitty's anorexia.)

Cousin L. (angrily): She said she had bulimia, but I never saw any evidence of it, and I'm a clean freak. I think I would have seen it.

Me: Why would she say she had it if she didn't? And didn't she end up in the hospital with a burned esophagus at one point?

Cousin L.: Well, all I can tell you is that she's big as a house right now. Big as a house.

Me: (just looking at her, saying nothing)

Cousin L.: It's a shanda the way she's let herself go. I've lost a lot of weight recently, and so has J. (her other daughter). Doesn't she look great?

Me: I wish A. had come to the reunion. I'd like to see her.

Cousin L.: (walking away) Big as a house. It's terrible.

This conversation pretty much embodies my family's attitudes toward eating disorders and weight--and, I daresay, the attitudes of many. Eating disorder, shmeating disorder, right? We don't take that stuff seriously. It's all a put-on, a game, a manipulation. But fat--now that we take seriously. Being fat is a crime. You shouldn't leave your house if you're too fat. You wouldn't want anyone else to see you.

And that's why I live a thousand miles away from my extended family. And always will.

OT: Bat mitzvah follow-up

I couldn't resist linking to this delightful blog, written and illustrated by a woman who attended my younger daughter's bat mitzvah a few weeks ago as a visitor to our community.

It's an unexpected perspective on not only my daughter's bat mitzvah but on being Jewish in America. And it's so much fun to read and look at. Enjoy!

Accused of anorexia

This morning I read yet another news story that described yet another celebrity "accused" of anorexia. That's the word the news story used: accused.

And it made me wonder. It's not the first time I've read this and it won't be the last. We accuse people of crimes, of transgressions, of doing wrong. Is having anorexia a crime?

I think the word choice speaks worlds about how we see eating disorders: as choices made to get attention, to punish others, to--fill in the blanks. For all our talk about eating disorders as diseases, we still--and by we I mean the culture at large--see them as manipulative choices people make.

When I read a story like this, I wonder what those who make such "accusations" are thinking. Is it something like "Aha, I caught you!" Do they feel superior to celebrities who might be ill with eating disorders?

The same magazines and newspapers that trumpet such accusations, of course, also report obsessively on every pound that celebrities, especially women, gain and lose. They write headlines about women who lose their baby fat 2 weeks after giving birth--as if this was not only a natural but a desirable state of affairs.

So the message is what? Be very thin, but not too thin? Where is the invisible line separating good-thin from bad-thin? If being thin is such a necessary condition, why is being too thin a crime?

Food for thought on a how summer's day.

Roundup of interesting medical news

I don't have much time for writing original posts right now, but here are a couple of recent studies that seem interesting for one reason or another to me. Discuss.


Farm-raised tilapia fish contains potentially dangerous fatty acid combination: Farm-raised tilapia, one of the most highly consumed fish in America, has very low levels of beneficial omega-3 fatty acids and, perhaps worse, very high levels of omega-6 fatty acids, according to new research from Wake Forest University School of Medicine.

A suspect found for SIDS
: New evidence is suggesting that a chemical imbalance in the brain may be the cause of some cot deaths.

Statins have unexpected effect on pool of powerful brain cells: Cholesterol-lowering drugs known as statins have a profound effect (and not necessarily a good one) on an elite group of cells important to brain health as we age, scientists at the University of Rochester Medical Center have found. The new findings shed light on a long-debated potential role for statins in the area of dementia.

Brain food - what we eat affects our intelligence: New research findings published online in The FASEB Journal provide more evidence that if we get smart about what we eat, our intelligence can improve. According to MIT scientists, dietary nutrients found in a wide range of foods from infant formula to eggs increase brain synapses and improve cognitive abilities.

Mazel tov Lulu!

Today is Lulu's bat mitzvah. Mazel tov, my dear daughter!

Make the call for mental health parity

According to the Eating Disorders Coalition, a lobbying group that Maudsley Parents is affiliated with, July 9th is National Call-in Day for mental health parity.

Says the EDC:

The US House of Representatives and the Senate negotiators have reached a final agreement on all the remaining mental health and addiction parity issues. However, approximately $4 billion over 10 years in offsets is needed to pay for the bill and must be found before parity can be brought to the floor in both chambers for final passage. Once an offset has been found, there is commitment from leadership in the House and the Senate to bring the bill up for a vote as quickly as possible.

Although House and Senate leaders have not decided yet where they will find almost $4 billion over 10 years to pay for the cost offsets required by Congressional rules, negotiations have successfully concluded on the key policy provisions. This compromise is the result of long negotiations and advocacy of organizations all across the country. The compromise includes many key provisions that were included in the House-passed bill, the Paul Wellstone Mental Health and Addiction Equity Act and would be an important step in ending insurance discrimination facing people with addiction and mental illness. Here are some key points in the compromise:
- The compromise requires parity in insurance coverage for addiction and mental health treatment for both in-network and out-of-network coverage. This does not mean that the bill requires that insurers cover addiction and mental services, only that if they do cover these services, there must be parity with medical/surgical benefits. This of course would be a very positive development both in requiring fairness in insurance coverage and taking a strong stand against discrimination toward people in recovery or still suffering from addiction and mental illness.

- The compromise requires plans to disclose their medical necessity criteria and reasons for any denials of coverage. This would be a major breakthrough, as many plans refuse to disclose medical necessity criteria or reasons for denial, especially when addiction treatment is sought.

- On the issue of protection of state laws, the compromise bill language is silent. The House bill explicitly protected state laws, and in earlier versions the Senate bill explicitly preempted state laws. Silence is a victory for those of us who agree with the House approach that state laws should be protected, since in most situations Congress must take explicit action to overrule a state law in order for state laws to be preempted. However, to make protection of state laws even more ironclad, we will be working to ensure that the legislative history of the bill makes clear that the sponsors’ intention is to protect all state laws. That way, as important as the passage of a federal parity law would be, stronger state laws would remain in effect and states would be free to enact additional stronger protections in the years to come.

Wednesday July 9th is National Call-in Day so please call your Member of Congress and Senators on July 9th and tell them that now that an agreement has been reached between the House and the Senate, Congress must find the money to fund this historic mental health and addiction parity legislation and pass parity now.

For more information, visit our National Call-in Day Online Advocacy Action Center.On the website you will see background information, a script for the call and a tool you can use to punch in your zip code and get your Member of Congress and Senator’ names and phone numbers.

Take the Parade poll

In this week's issue of Parade magazine, the editors invite readers to go online and vote whether or not “obese” passengers should buy two seats. So far 83% say yes, 17% say no.

Go vote.

UPDATE: The tally is now Yes 57%, No 43%. Woo-hoo!

Be part of an eating disorders study

If you or someone you love has or has had an eating disorder, you (or s/he) might be eligible to be part of one of these ongoing studies. Treatment is often free if you're part of a study. And you're helping advance the pitiful state of e.d. research, which is always a good thing.

* * *

Have you been affected by an eating disorder in the San Diego area? You may qualify to participate in a study that could help clinicians understand and treat eating disorders. Does the following describe you? You are a girl/young woman between the ages of 13 and 25: you are currently in treatment for an eating disorder; you are medically stable; and you have used the internet to look at ANOREXIA websites. Following a brief telephone screening, you will be asked to fill out a brief survey and participate in a one-on-one interview with a doctoral student from Alliant International University. Your total time commitment will be no longer than 2 hours. All identifying information about you will be kept confidential. You will be compensated with a $20 gift card to Westfield Malls (UTC, North County Fair, Horton Plaza, Plaza Bonita) and will be entered into a drawing for one $150 gift card. For more information contact PattyschroMA@sbcglobal.net.



San Diego, CA: UCSD Researchers Seek Males and Females with Anorexia Nervosa: The UCSD researchers are currently seeking adolescents and adults currently suffering from Anorexia Nervosa to participate in one of their three current studies. To qualify for any of the studies one must be at least 15% below ideal body weight and be fearful of weight gain, despite being underweight. Both adults and adolescents between the ages of 14-45 are needed to participate in a taste study and would be compensated for up to $70 for completing the assessments, taste tests and interview. Adults 18 years of age and older are needed to participate in a randomized control trial of the medication Quetiapine, in which they will receive either the study medication or a placebo. Subjects will be compensated up to $360 for completing study related assessments and the medication treatment. In addition, they are offering several months of family therapy treatment for families with adolescents between the ages of 12 and 18 at no cost. The adolescents in this study will also be randomly assigned to receive either the medication Fluoxetine or a placebo. For more information, contact UCSD Eating Disorder Treatment and Research Program at 858-366-2525 or email edresearch@ucsd.edu.



San Diego, CA: UCSD Researchers Seek Women Recovered From an Eating Disorder: Help UCSD researchers understand what causes eating disorders. They are seeking female participants between 18 and 45 years of age who are recovered from Anorexia or Bulimia Nervosa. By participating in the study, subjects will be assisting physicians and researchers in developing new treatments for these complex and serious disorders. Subjects will be compensated for your participation in this study. For more information contact the UCSD Eating Disorder Research and Treatment Program at 858-366-2525 or email edresearch@ucsd.edu.



Massachusetts Research Study - Massachusetts General Hospital Study of Therapy for Bone Loss in Anorexia Nervosa: The Neuroendocrine Unit of Massachusetts General Hospital is conducting research studies on anorexia-induced bone loss. Their screening study is for men and women age 12-50 with anorexia nervosa. They are investigating causes of osteopenia (or bone loss) in the spine, hip, wrist and total body. The study involves one visit of approximately 3 hours. Their treatment study is for women aged 18-45 with anorexia nervosa and absent or irregular menstrual periods. They are investigating the combined use of a natural hormone and a medication that is effective for bone loss in postmenopausal women as a novel treatment for the bone loss seen in women with anorexia nervosa. They hope that the combination of these two investigational medications will help rebuild depleted bone and prevent further bone breakdown in women with anorexia nervosa. The study consists of 6 visits over 12 months. A stipend of up to $675 is awarded throughout the course of the study. If interested, call Erinne Meenaghan, N.P. at 617-724-7393 or email nedresearchstudies@partners.org.



Massachusetts: Bulimia Nervosa Study: Free confidential treatment is available to those who are eligible. Do you or someone you know binge eat? Do you or someone you know compensate by vomiting or other extremes? Do you or someone you know have severe moodiness or relationship problems? Researchers are now enrolling participants (ages 18-65) in a free treatment study investigating two active treatments, including education and counseling, for bulimia nervosa. If interested call 617-353-9610 or click here.



New York, NY: NIMH-funded, IRB-Approved Study of Adolescents with Bulimia Nervosa (ages 12 - 21 years). This study takes place at NYSPI/Columbia University and compensation is provided for participation ($100). For more information, contact Laura Berner at 212-543-5316. P.I.: Rachel Marsh, Ph.D., Assistant Professor of Clinical Psychology, Columbia University/ New York State Psychiatric Institute, phone 212-543-5384, email marshr@childpsych.columbia.edu.



New York, NY: The National Institute of Mental Health is sponsoring a multi-center international study to compare two types of family therapy as well as fluoxetine or placebo (an inactive medication) in the treatment of adolescents with anorexia nervosa. They are looking for families with an adolescent with anorexia nervosa between the ages of 12-18 years. Participation involves completing assessment interviews, questionnaires, and engaging in 16 family therapy sessions over the course of nine months with medication continuing for another six months. The study is being held at the Eating Disorders Research Program, The Westchester Division of New York-Presbyterian Hospital, Weill Medical College of Cornell University. Contact the Research Coordinator, Samantha Berthod, MA at 914-997-4395.



Pittsburgh, PA: Seeking Women Recovered from Anorexia or Bulimia Nervosa. Dr. Walter Kaye and his research team at the Eating Disorders Research Program at the University Pittsburgh Medical Center are looking for women who have recovered from anorexia or bulimia nervosa for a research study on brain chemistry in eating disorders. Study participants must be between 18 and 45 years old, medication free (birth control pills acceptable) and not pregnant or nursing. The study involves phone interviews, questionnaires, PET and MRI scans, lab work, physical exam, two visits to Pittsburgh and 8 weeks of fluoxetine (generic form of Prozac). (Note: All expenses incurred during the study, e.g. travel expenses, lab work, physical exam and etc. are paid for by the study.) In addition, eligible participants will be compensated up to $1300 upon completion of the study. For more information, email EDResearch@upmc.edu or Dr. Kathy Plotnicov at plotnicovkh@upmc.edu or Dr. Sharon Barnes at barnessd@upmc.edu. Interested parties can also call toll-free at 1-866-265-9289 or submit a contact form online here.

If you live in Scotland, you'd better not be fat

Because if you are, according to the Sunday Herald, your doctor can prescribe Accomplia (generic name: rimonabant) if you haven't "responded to other treatments"--i.e., if you're still fat despite his/her best advice.

That's because Scotland has gone completely bonkers on the subject of fat. Especially when it comes to the children. According to a spokesman for the Scottish National Health Service, "Being overweight or obese during childhood can lead to physical and mental health problems in later life, such as heart disease, diabetes, osteoarthritis, back pain, low self-esteem and depression."

Maybe he hasn't seen this study on how feeling bad about your weight is much worse for your health than actually being fat.

Accomplia, on the other hand, has been linked to depression and other mental health issues, heart attacks, and suicide. Sounds like a perfect "fix" to me.

Thankfully, not everyone in Scotland has leapt onto the anti-obesity train. The Sunday Herald quotes Dr. Ken Paterson, chairman of the Scottish Medical Consortium, as having said, ". . . our advice is that [the drug] shouldn't be used. . . . People regain weight very quickly when they come off this drug, so the real question is what is the benefit of having a short-term, non-sustained weight reduction? We don't believe it should be in general use."

I worry, I really do, about what life will be like here and elsewhere in 10 or 15 years if you're fat.

Why I am a fan of Leora Pinhas

She's a psychiatric director for the eating disorders program at the Hospital for Sick Children in Toronto. At the recent Canadian Pediatric Society Conference, Dr. Pinhas said two things that endeared her to me.

First, she compared childhood eating disorders to cancer:

"We have this thing that [they're] not really serious. But one in 10 will die. We need to act like it's a serious illness."

Thank you, Dr. Pinhas.* And thank you even more for going on to put the question of eating disorders into the context of the ever-more-prevalent obsession with childhood obesity:

Pinhas dismissed the attention being given to childhood obesity rates - which she says have not increased since 2003 and have not increased in any clinically significant way since the late 1990s.

The most disturbing thing about the constant news about obesity rates is it's likely fuelling eating disorders, Pinhas said.

"Dieting is the gateway to eating disorders. If you have people encouraged to diet because being fat is so bad, you're only giving them an intervention that will make them fat, or give them an eating disorder or make them feel bad about themselves."

In the current culture, which supports weight-loss interventions for children as young as 2, Dr. Pinhas' perspective is not just refreshing--it could be a life-saver.


*Though she also went on to say that "most people recover from eating disorders." I'd like to know where that statistic comes from, since the numbers I've seen are far bleaker.

The girl at the mall

I noticed her right away, as I always do now: 9 or 10 at first glance, with the thin, prepubescent body of a girl who hasn't begun puberty yet. On second glance I could see she was older--something about the curve of her shoulder, the way she carried her purse, the look on her face, more knowing than a 9-year-old, and more weary, too. I could see the shape of her arm bones under the skin, the sharp edge of her collarbone.

She was shopping with her mother; I was shopping with my 12-year-old. They were discussing a dress, the very dress, it happened, that my daughter had her eye on. The mother hung it back on the rack and my daughter picked it up. "Look, Mom, I love this!" she said. Then she looked at the size--size 7--and regretfully put it back.

I asked the other mother, "How old is your daughter?"

The mom smiled and shook her head. "She's 12, but she thinks she can wear a size 7. She swears it fits and I told her I'm not buying it."

I looked at the girl, her strained smile, her impossibly thin waist. I looked at the mother. I made a decision.

"Could I have a word?" I asked.

I told her my daughter had had anorexia, that I saw some of the same signs in her daughter I'd seen in mine. I told her that her daughter looked worryingly thin, that wanting to wear a size 7 when you're 12 could very well reflect the distorted thinking of an eating disorder. I told her I hoped her daughter wasn't sick but that if I were her, I would take her to the doctor right away.

By the time I was done talking the mother was backing up. "OK, thanks," she said, edging away from me, and they were gone.

I can't get the girl at the mall out of my mind. I wonder what her mother will do. I wonder if I did the right thing to speak to her.

What would you have done?

If your child has an eating disorder, read on. . . .

I've written before and recently about how eating disorders affect the entire family. E.d.s are incredibly stressful for both sufferers and the people who love them.

So I was interested to see this study, showing that even mild stress, if it's chronic, affects cognitive abilities in rats. It makes them forget things they've just learned and alters their neuroimmune and neuroendocrine systems.

Of course this applies to any families dealing with acute or chronic illness.

Me, I'm glad to know that there were sound physiological reasons for my post-recovery meltdowns. So if your child is doing well (and especially if she's not), and you're forgetful, irritable, can't concentrate--just know that it's not your fault and that there are good reasons for your brain drain.

A headline I couldn't resist

Obesity Researchers May Need Jaws Wired Shut

Warning: There's an egregious fattie picture accompanying this article--not headless but with eyes rolled back in ecstasy? abandon? seizure? as the fork is lifted. But there are some pretty good lines in here.

Big Brother has arrived . . . in Japan

This article made my jaw drop over my morning tea. I don't know why--this kind of government intrusion into private lives is the logical consequence of all the anti-obesity hype we're hearing. It's coming here too, I fear, under the guise of a national health plan that ties "wellness" to "consequences."

But here's the thing: In Japan, talk about eating disorders is very hard to come by. I sit on a committee at the Academy of Eating Disorders with international representation, and the member from Japan has talked repeatedly about how hard it is to get any of the media there to write about eating disorders. And how difficult it is to discuss e.d.s in Japan.

And yet the Japanese government is imposing sanctions on those whose waists exceed a randomly set number?

Once again, the connection between the war on obesity and eating disorders scares the hell out of me. For good reason.

Overweight? Try this

I've been slow to post these days, for which I am sorry. Life is hectic right now.

But plenty of other people have been posting these days. One of my favorites of recent weeks is Carrie Arnold's post from yesterday. It's parody of the best kind--sarcastic as hell and oh-so-true in spirit. Jonathan Swift would have approved.

SOTD*: Teens and "eating problems"

A new study out of Finland and reported in the Journal of Advanced Nursing asked 15- to 17-year-olds to report on whether they had eating "problems" along with a host of other health issues (insomnia, depression, etc.). About 18 percent of teens said they had some level of eating problems that persisted over two years. I'd love to know exactly what "eating problems" means in this context--it could be anything from picky eating to active restricting/purging.

Interestingly, and right in line with other new research, there was a strong correlation between eating "problems" and anxiety/depression:

• 47% of students with persistent problems reported anxiety, compared with 12% of non reporters.
• 31% reported depression, compared with 5% of non reporters.
• 77% were unhappy with their weight and 46% with their appearance. This was much higher than the 8% and 18% reported by students without eating problems.

So far, so good. Researchers went on to look at height and weight records kept by school nurses and "found that even students with persistent eating problems were more likely to be normal weight than over or underweight."

From this they concluded, "Our study backs up previous research that shows that eating problems often fluctuate in children of this age and in 50 to 60% of cases last about one to two years. However in ten per cent of cases their eating problems can persist into adulthood. Although almost a fifth of the students who took part in our study reported eating problems at some point, these problems clearly sorted themselves out in the majority of cases. However, one in twenty students continued to report problems."

I'm not so sure about that. First of all, these were self-reports, and we all know that even under the best circumstances, self-reports are notoriously unreliable. Second, teens with eating disorders tend to be ansognosic--they can't recognize that they have a problem.

It makes me wonder about the teens who said they did have problems, and what relationship those "problems" have with eating disorders.

It's quite a stretch to conclude from this that the majority of teenage eating issues last one to two years and then "clearly sort themselves out." Maybe the kids just got savvier about hiding e.d. behaviors and stopped self-reporting. Maybe the kinds of problems they were describing aren't related to true eating disorders in the first place. Maybe they had some help in resolving those eating problems that wasn't identified in the study.

I'm grateful to see more studies on eating disorders, but sometimes surprised by the level of analysis brought to the table (so to speak).



*SOTD = study of the day

And this just in: Aetna settles!

Remember the class action lawsuit brought by New Jersey mom Dawn Beye, among other plaintiffs?

Well, Aetna, the insurer in question, has just settled. Not only will it pay 100 or so New Jersey families whose e.d.-related claims were denied, but:

For people enrolled in fully insured policies, "Aetna shall cover claims submitted by Aetna Insureds for the diagnosis, care and treatment of eating disorders in the same manner as biologically based mental illnesses," the May 22 settlement in DeVito v. Aetna Inc., civ-07-418 says.

I'm lifting my breakfast fork in celebration here. The Aetna settlement closely follows the Minnesota Blue Cross Blue Shield settlement brokered by a suit involving Kitty Westin some years ago.

This is Progress with a capital P. Go read for yourself.

The "other end of the spectrum"

This article in the Milwaukee Journal Sentinel caught my eye the other day. Whoever wrote the headline--"Young females may be on the path to poor bone nutrition"--missed the real point here, which to my mind is captured in these paragraphs:

One of the most surprising findings was that nearly twice as many of the non-athletes (30%) had poor bone health, compared with the athletes. More than 90% of the non-athletes also were getting insufficient calcium.

The finding shows that while overeating and obesity are problems for a significant number of adolescents, at the other end of the spectrum is a group of young girls who have poor nutrition habits, including not eating enough.

Yes, folks, despite 200+ years of knowledge about eating disorders, we are still surprised to hear that some young women do not eat enough.

Sarcasm aside, I am thrilled beyond measure to read things like this:

"A lot of times we are so focused on obesity that it can play into eating disorders," said Sheila Dugan, an assistant professor of physical medicine and rehabilitation at Rush University Medical Center in Chicago. Dugan was not a part of the study.

Yes, yes, and yes. I am terrified that 5 or 10 years from now, when the children who are now getting a whopping dose of "wellness" curricula in elementary schools hit adolescence, we're going to see a spike in the number of cases of eating disorders.

The last time I tried to make this point to someone In Charge (in this case, a new head of a university hospital's child and adolescent programs), she looked at me like I had two heads.

But osteoporosis is a quantifiable measure. It's not a subjective assessment of eating habits or self-reported nutrition. It's undeniable numbers and for that I am grateful. If that's what it takes to get those In Charge to pay attention, that's a good thing.

Now, who's listening out there?

Research opportunities

Here's a round-up of research opportunities relating to eating disorders. If you're eligible for one of these studies and you feel comfortable participating, I encourage you to do it. God knows we need more research on e.d.s. Do it for yourself and for all those who will come after you.

And let's raise a fork to the end of eating disorders.


San Diego, CA: UCSD Researchers Seek Males and Females with Anorexia Nervosa: The UCSD researchers are currently seeking adolescents and adults currently suffering from Anorexia Nervosa to participate in one of our three current studies. To qualify for any of the studies one must be at least 15% below ideal body weight and be fearful of weight gain, despite being underweight. Both adults and adolescents between the ages of 14-45 are needed to participate in a taste study and would be compensated for up to $70 for completing the assessments, taste tests and interview. Adults 18 years of age and older are needed to participate in a randomized control trial of the medication Quetiapine, in which they will receive either the study medication or a placebo. Subjects will be compensated up to $360 for completing study related assessments and the medication treatment. In addition, we are offering several months of family therapy treatment for families with adolescents between the ages of 12 and 18 at no cost. The adolescents in this study will also be randomly assigned to receive either the medication Fluoxetine or a placebo. For more information, contact UCSD Eating Disorder Treatment and Research Program at 858-366-2525 or email edresearch@ucsd.edu.

San Diego, CA: UCSD Researchers Seek Women Recovered From an Eating Disorder: Help UCSD researchers understand what causes eating disorders. They are seeking female participants between 18 and 45 years of age who are recovered from Anorexia or Bulimia Nervosa. By participating in the study, subjects will be assisting physicians and researchers in developing new treatments for these complex and serious disorders. Subjects will be compensated for your participation in this study. For more information contact the UCSD Eating Disorder Research and Treatment Program at 858-366-2525 or email edresearch@ucsd.edu.

Massachusetts Research Study - Massachusetts General Hospital Study of Therapy for Bone Loss in Anorexia Nervosa: The Neuroendocrine Unit of Massachusetts General Hospital is conducting research studies on anorexia-induced bone loss. Their screening study is for men and women age 12-50 with anorexia nervosa. They are investigating causes of osteopenia (or bone loss) in the spine, hip, wrist and total body. The study involves one visit of approximately 3 hours. Their treatment study is for women aged 18-45 with anorexia nervosa and absent or irregular menstrual periods. They are investigating the combined use of a natural hormone and a medication that is effective for bone loss in postmenopausal women as a novel treatment for the bone loss seen in women with anorexia nervosa. They hope that the combination of these two investigational medications will help rebuild depleted bone and prevent further bone breakdown in women with anorexia nervosa. The study consists of 6 visits over 12 months. A stipend of up to $675 is awarded throughout the course of the study. If interested, call Erinne Meenaghan, N.P. at 617-724-7393 or email nedresearchstudies@partners.org.

Massachusetts: Bulimia Nervosa Study: Free confidential treatment is available to those who are eligible. Do you or someone you know binge eat? Do you or someone you know compensate by vomiting or other extremes? Do you or someone you know have severe moodiness or relationship problems? Researchers are now enrolling participants (ages 18-65) in a free treatment study investigating two active treatments, including education and counseling, for bulimia nervosa. If interested call 617-353-9610 or click here.


New York, NY: NIMH-funded, IRB-Approved Study of Adolescents with Bulimia Nervosa (ages 12 - 21 years). This study takes place at NYSPI/Columbia University and compensation is provided for participation ($100). For more information, contact Laura Berner at 212-543-5316. P.I.: Rachel Marsh, Ph.D., Assistant Professor of Clinical Psychology, Columbia University/ New York State Psychiatric Institute, phone 212-543-5384, email marshr@childpsych.columbia.edu.


New York, NY: The National Institute of Mental Health is sponsoring a multi-center international study to compare two types of family therapy as well as fluoxetine or placebo (an inactive medication) in the treatment of adolescents with anorexia nervosa. They are looking for families with an adolescent with anorexia nervosa between the ages of 12-18 years. Participation involves completing assessment interviews, questionnaires, and engaging in 16 family therapy sessions over the course of nine months with medication continuing for another six months. The study is being held at the Eating Disorders Research Program, The Westchester Division of New York-Presbyterian Hospital, Weill Medical College of Cornell University. Contact the Research Coordinator, Samantha Berthod, MA at 914-997-4395.


Pittsburgh, PA. Seeking Women Recovered from Anorexia or Bulimia Nervosa. Dr. Walter Kaye and his research team at the Eating Disorders Research Program at the University Pittsburgh Medical Center are looking for women who have recovered from anorexia or bulimia nervosa for a research study on brain chemistry in eating disorders. Study participants must be between 18 and 45 years old, medication free (birth control pills acceptable) and not pregnant or nursing. The study involves phone interviews, questionnaires, PET and MRI scans, lab work, physical exam, two visits to Pittsburgh and 8 weeks of fluoxetine (generic form of Prozac). (Note: All expenses incurred during the study, e.g. travel expenses, lab work, physical exam and etc. are paid for by the study.) In addition, eligible participants will be compensated up to $1300 upon completion of the study. For more information, email EDResearch@upmc.edu or Dr. Kathy Plotnicov at plotnicovkh@upmc.edu or Dr. Sharon Barnes at barnessd@upmc.edu. Interested parties can also call toll-free at 1-866-265-9289 or submit a Contact Form online here.

An open letter to parents

Dear Parents,

I know it's hard to raise a child in this day and age for all kinds of reasons. And I know that one of those reasons is all the messages you get about your child and weight.

I know that parents often get shamed, these days, if their child's weight is too high (or too low). That there's enormous pressure for kids to slim down and look a certain way. To fit the current cultural norms around appearance and weight.

But for god's sake, I beg you, don't send your child off to a place like this. If you've ever been tempted to send your child off to fat camp, read this article in the Washington Post. Read about a "camp" where growing teenagerss are forced to eat such a low-fat low-everything diet that eight of them developed gallbladder disease in the last year.* Where six of them needed gallbladder surgery. Where kids routinely douse their food with ketchup and mustard.** Where hungry teenagers drink 12 or 15 cans of diet soda a day, all of it laced with Splenda.*** Where the director of the whole place thinks it's OK if kids gorge on cake occasionally because they'll just throw it up again.**** Where kids are put into "solo" when they break the rules.

Most of all, what a place like this does is reinforce the idea to your child that s/he is not OK as s/he is. That she's acceptable only if she loses weight. That she's not lovable as she is.

And that's the very worst part of this whole trend. As parents, we're supposed to build our children up, not undermine them. We're supposed to be voices of reason in a sometimes crazy world.

So if your child doesn't fit today's paradigm for weight or attractiveness, love her anyway. Tell her she's beautiful and strong and lovable and smart. Teach her to love herself. That's the way to health and beauty. The other will lead her down a lifelong path of hating herself. And I can tell you from personal experience that that's not the way to health and beauty.


*Gallbladder disease can be caused by weight loss that's too fast.

** A classic sign of malnutrition/starvation. The volunteers in Ancel Keys' starvation study did the same. So did my daughter when she was anorexic.

***A friend of mine was temporarily blinded by Splenda. She leaned over a pot on the stove at just the wrong moment, and was blinded by the chlorine gas released from the Splenda-laced concoction. You definitely don't want your child drinking Splenda. Especially not 15 servings a day.

**** As my friend Jane says, hello bulimia.

The real face--and sound--of Russian ballet

The online trailer to David Kinsella's new film about Russian ballet, A Beautiful Tragedy, shows a young woman who is training at one of Russia's premier ballet schools. Against a background of piano music we see her beautiful, expressive face contort with effort as she works. And we hear--most extraordinarily--her panting. It's the sound of ballet, a sound you don't hear from the audience at a performance. It's the sound of a young athlete and artist working to her fullest capacity.

We also see her face, and the faces of several other young dancers in the film. They have the gaunt and haunted eyes, the protruding bones, of anorexia. According to Kinsella, dancers at this school in Russia must keep their BMIs down to about 14. These young, growing girls learn to punish themselves, to starve, to obsess about fat, all in the name of beauty. A particular notion of beauty.

I'm glad I'm not a ballet lover, because I don't think I could sit through another ballet without seeing these girls' faces and hearing, in my mind, the sound of that determined, exhausted breathing.

Childhood obesity: the deconstruction

Over at the Rocky Mountain News, Paul Campos has posted a brilliant response to some of the hyped-up points made in the Washington Post's current (and ridiculously overblown) series on childhood obesity--and issued a challenge. A $10,000 challenge, to be exact, to the lead author of the 2005 study that predicts a two-to-five-year drop in life expectancy "unless aggressive action manages to reverse obesity rates."

Campos rebuts some of the war-on-childhood-obesity's usual points with elegance and clarity. For instance, to put some of the current hyperbole in context, he points out, "Ever since public health records began to be compiled in America in the mid-19th century, the following statement has always been true: Today's children are both larger and healthier, on average, than those of a generation ago."

One of the most commonly repeated predictions by fervent generals in the war on childhood obesity is that because children are fatter today, their lives will be shorter. What could possibly strike more fear into a parent's heart? I think this prediction is at the heart of the current hype, and clearly Campos agrees, because his challenge to the author of the 2005 study involves a more thorough examination of the data:

If, at any decennial census going forward, obesity rates have risen or remained the same, and life expectancy in America has declined, I'll pay [the author] $10,000. If we don't get any thinner but life expectancy has risen, he'll pay me the same sum.

I look forward to Round 2.

Sex and drugs and pharmacies

Over at Junkfood Science, Sandy Szwarc had an excellent post today on the rather incredible prevalence of prescription drugs in America today and the financial motives behind such large-scale prescribing.

Full disclosure: I'm in favor of meds for those who need them. Actually, I often wish SSRIs had been around when I was a teenager. I often wonder who I might have become had I not had to deal with the continuous panic attacks that started around age 11. Living in constant terror shaped me, body and soul. For better or worse.

Still. Some of the statistics Szwarc quotes are staggering: More than half of all insured Americans take some kind of prescription for a chronic condition. (Note that it's 50 percent plus of insured Americans.) Nearly half of all young women in this country now take ongoing meds. Likewise one in three children.

As Szwarc points out, pharmacy benefit managers stand to gain big bucks from the rise in chronic prescriptions. But most doctors don't benefit directly from prescriptions. They have patients' best interests at heart. The trouble is in how one defines best interests.

Case in point: The women in my family tend to have high cholesterol. My mother has it. My grandmother had it. And I've got it. When my cholesterol level first turned the wrong way, my (former) doctor encouraged me to "eat right and exercise." I did, and I do. I'm no fitness queen, but I try to walk or bike for 45 minutes every day, and I try to be active in other ways too. I eat a wide variety of foods, including plenty of fruits and vegetables. None of this affected the cholesterol numbers, which continued to inch upward. Then my doc started trying to convince me to go on statins. Every time I saw her she suggested I give them a try. After about two years of this she sat me down and said, "If you were my sister I'd put you on these right now." She went on to scare the living crap out of me with accounts of young people who'd had heart attacks and strokes. Statins, she said, would prevent all that.

Never mind the fact that there's pretty much no history of heart disease or stroke in my family. None of us are thin. Few of us die early. I've got grandparents and great-grandparents on both sides of the family who lived into their upper 90s.

Still. I was scared. I went on a statin. I felt like crap, but I kept taking it. I never developed the full-blown myopathy that some people get from taking statins, but I did get increasingly depressed and never felt good. Two years later, I got a new doctor, and at our first appointment she asked about the statins. I told her how I felt--scared and crappy--and she took a thorough family and personal history. She told me my risk of having a heart attack or stroke were less than .5 percent, at least at this point, and took me off the statins. Within a couple of weeks I felt great again.

Back when Doctor #1 prescribed the statins, I asked her if she really thought a relatively healthy woman in her early 40s needed to be on cholesterol-lowering drugs for the rest of her life. She looked at me like I was nuts.

I'm sure she believed she was doing the right thing. And I'm just as sure that she wasn't. I guess time will tell.