Obesity and suicide

The lede of this story says it all:

As if the many physical health concerns associated with the obesity epidemic weren't worrisome enough, new research shines a light on an alarming mental health connection: Teenagers who are overweight are at higher risk of attempting suicide. Even teens who merely believe themselves overweight -- but actually are not -- are more predisposed to suicidal behavior, the researchers found.

As if reading stories like this weren't enough of a health risk. . . .

Why the shock, ladies and gentlemen? By now we know that the stigma associated with being fat in this society has devastating consequences for your health, mental and physical.

We know that hormonal shifts, poor impulse control, and other factors make teens especially susceptible to suicide.

Put the two together, and what do you get?

Shocking, no?

Say it after me: I-Am-a-Shill

My first reaction to this story on The Daily Beast was to look for the small print labeling it an ad. Sadly, it's not an ad but real-live editorial content. Sort of.

Written by one Dr. Susan Roberts, a professor of nutrition and professor of psychiatry at Tufts University (who also just happens to be the author of a brand-new! fabulous! dieting book), this piece purports to tell you why crash dieting is just as effective as "more gradual weight-loss" regimens.

Dr. Roberts left out one tiny factoid here: No diets are effective in the long-term.

So yeah, Dr. Roberts, maybe crash dieting is "just as effective" as Weight Watchers or Jenny Craig. But how could you have neglected to mention the fact that more than 95 percent of dieters not only gain back the weight they lost but they gain back more? Have you not seen the UCLA study showing that diets don't work? Maybe you think your new diet is better than every other diet that's ever been marketed. Or maybe you just don't care, so long as you make a buck here. Or a lot of bucks.

I expect better than this from a professor of psychiatry. And even, frankly, from Tina Brown's website. Brown used to be editor of The New Yorker, for god's sake, a magazine renowned for its fact-checking and reporting excellence.

How the mighty have fallen.

Watch. This. Please.

Do lesbians have better body image?

That's the intriguing suggestion made by this study, published in the March issue of the Journal of Women's Health (which is currently online free in honor of Women's Health Month). This study of young Australian women showed that lesbians had better body image than either bisexual or mainly heterosexual women. They were less dissatisfied with their weight and shape (notice the phrasing here: "less dissatisfied" as opposed to "happy with"), and less likely to engage in what researchers call "unhealthy weight control behaviors"--i.e., smoking, using laxatives, weight cycling, and skipping meals.

I could speculate as to what's behind this--couldn't we all?--but I'd love to know more. "Understanding why lesbians have a healthier body image would also provide insights into how to improve the body image of other groups," write the study's authors. Indeed.

Fat-friendly doctors

I'm writing a magazine piece right now on "women's diseases"-the disorders (often autoimmune) that have historically been pooh-poohed by doctors. I'm talking about diseases like chronic fatigue syndrome, lupus, MS, fibromyalgia, and PCOS. As part of my research, I've talked to many women with these diseases, especially PCOS, or polycystic ovarian syndrome. One of the telltale characteristics of a woman with PCOS is having very high levels of insulin, which wreaks all sorts of havoc on the body. And which, oh yes, makes you gain weight.

One of the women I interviewed talked about gaining 125 pounds in less than a year, without changing her diet or exercise habits--and then being told by a doctor that she had to "get your eating under control!"

Of course, you don't have to have PCOS or another illness to have had a run-in with fatphobic doctors. Many of the stories here speak to the same issues.

So for anyone who's ever had to deal with a doctor who just doesn't get it, here's a link to a fabulous list of fat-friendly health professionals around the world.

The site is maintained by one Stef Maruch. Thanks, Stef. You're doing us all a big favor.

Why the food and exercise police are unsuccessful

The human body is an amazing thing. Amazing! As every dieter knows, if you cut back on its fuel one day, you'll feel hungrier the next as your body tries to compensate. Turns out the same model applies when it comes to physical activity. If you give kids more gym time, more time spent running around, they become less active when they're not in school.

At least, that what a new study done in the Netherlands shows. The study results, presented last week at the European Congress on Obesity, demonstrated yet again why trying to manipulate kids' eating habits and weight through "interventions" is ineffective. Researchers looked at kids from three schools, who got 9.2, 2.4, or 1.7 hours of scheduled phys ed time in a school week, and found that kids' activity levels averaged out to be exactly the same no matter how much gym they got in school. Those who didn't get much PE time at school became more active at home, while those who got a lot of PE in school did less at home.

"We believe the range of activity among children, from the slothful to the hyperactive, reflects not the range in environmental opportunities, but the range of individual activity set-points in the brains of children," said Alissa Frémaux, a biostatistician (I didn't even know there was such a thing! very cool) who analyzed the study.

I think more PE time in schools is a great thing, especially when there are big gaps in the socioeconomic status of kids. While some kids get carted around to ballet and soccer, too many kids have no opportunities outside of school to move, be active, exercise, and have physical fun. So I'm all for piling it on at school.

Just don't expect more gym time to equal thinner children. And don't think that lowering the fat content of school lunches will translate into thinner kids, either.*



*I am deliberately leaving aside the notion of whether these are desirable outcomes. The plain truth is that they're not achievable. Constant readers know what I think anyway.


**Thanks, as usual, to Jane for pointing me toward this research.

Guest post: One woman's story

This moving guest post, written by a 36-year-old reader, expresses vividly one young woman's slide into disordered eating and then an eating disorder. Her story involves a family that unwittingly triggered her ED. For every family like this, there are many others who do not value their children's thinness above all, and who don't contribute to pathology. So while I don't agree with her conclusion that "It's hard to have an eating disorder without the support of family and friends," I know from my own family's experience just how much validation and--as she points out--admiration comes your way just for being thin. Many of us don't realize we're validating pathological behaviors. I hope this will be a wake-up call for some.

A few months before my younger sister's wedding, she jokingly challenged my older sister and I to lose weight. My younger sister is very petite. She has always been very skinny. My parents (especially my mother) adore her.

At the time I was going through a spiritual crisis and felt a loss of control. I decided to go on a calorie-counting diet. I felt I couldn't control other things in my life. But I COULD control what I ate, and I could control how much I weighed.

It started fairly healthy. I bought a food scale and allowed myself the minimum amount of calories that experts recommend. My feeling is I'd get to my goal weight for the wedding, and when that was done I'd go off the diet.

I started off this diet as someone who has never really been overweight. I just wasn't thin like my sister. My weight was within the recommended ranges.

By the time the wedding came around I was thin. My parents were so proud. My dad even made comments in private about how he thought my beauty overshadowed the bride's. I received so much attention. I felt so proud. One of my parent's friend's kept praising me about my amazing willpower. One aunt did express concern. She said I looked too thin. I remember loving this attention.

At the wedding, I ate...a LOT. After weighing myself I realized that I couldn't just go off the diet. All the weight would come back. I'd have to stay on the diet for life. I told myself that was fine. I'd go on breaks sometimes and eat what I want.

My life and happiness became centered on these breaks which usually occurred on holidays and trips. Food became the center of my life. Nothing else could really excite me or make me happy. I'd spend hours and hours looking at restaurant and food websites.

Meanwhile, I kept wanting to lose more weight. Soon I came to the point where my weight at my sister's wedding seemed fat to me.

I don't think I had a body image distortion problem. I knew I was thin. I didn't look in the mirror and see a fat person. I saw a beautifully thin person. (Now though I look back at these photos and I AM thinner than I imagined).

The wedding had been in May. By Thanksgiving, I was underweight. My birthday was around this time and has a gift my mom took me shopping. She was so proud of my weight loss--bought me clothes to show it off.

At Thanksgiving, I opened my presents. Everyone wanted me to try the clothes on. Even though I was underweight, they had bought me clothes that were still tight. I could wear them, but I knew if I gained a little weight, I could no longer wear them.

I wasn't a teenager during all this. I was a mother with a four year old son and an aunt with two nieces. I think a part of me knew I had a problem, but another part of me denied that. I remember seeing someone horribly thin jogging and thinking. I am NOT like her. I'm okay.

I didn't want to die and leave my child an orphan. I told myself I was fine. I told myself there was a difference between eating disorders and strict healthy dieting. But I think a small part of me knew I was fooling myself. Maybe? I'm actually not sure.

The dieting continued. The numbers on the scale got lower.

During the beginning of the dieting, I had begun walking. I'd put my son in a stroller and do a long walk everyday. (or almost every day) My parents were very impressed with this. I received a lot of praise. Eventually, I bought a pedometer and made outrageous rules about how much I'd have to walk each day. I'd do this by never sitting down. I'd just walk and walk around the house--constantly. I remember having guests over and wanting them to leave because I was too embarrassed to obsessively walk in front of them. I felt they were intruding on my walking time.

I made rules for myself such as you can't eat another piece of food until you walk a certain amount of steps.

I started wanting to take more breaks from the diet. I made rules that if I was at a certain weight I could do this. I started drinking herbal laxative teas in hopes that this would make me lose those extra pounds. I didn't have much luck. My system was so slow at that point. I stopped having daily bowel movements.

About a year and a half after it all started, I received comments on my Livejournal blog from an anonymous stranger. An LJ friend had recovered from an eating disorder and was disturbed by my constant public recording of my weight. She approached another ED friend and they gave me a mini-intervention. She said it seemed like I had an eating disorder. She talked about my issues of control. And she scolded me for recording my weight. She said all this might be a trigger for someone.

I was furious and disgusted with her.

A few months later my sister (the thin one) approached me about the eating disorder. I actually don't remember my response. I can't remember if I denied it, or if by this time I knew I had a problem.

Eventually though I got over it.

I put away the scale (food and body). I stopped wearing a pedometer.

I stopped dieting.

I was disturbed to find myself quickly returning to my old weight, but I have grown to be mostly okay with it.

I have taken the scale back out, but I never weigh myself more than once a day. I also NEVER punish or reward myself based on my weight. I accept the number and realize there are so many things about myself that are much more important.

For the most part, I'm happy with myself.

I'm no longer obsessed with food. I like to eat, but it's definitely not the center of my happiness. My husband is a bit of a foodie and I actually get bored now when he starts going on and on about food.

I have had setbacks. My husband's friend went on a diet where you fast every other day. I read about it, decided it was safe, and tried it too. I lost a few pounds, but found myself obsessing about food again. I decided this was unhealthy and quit after a few weeks.

Every so often I have days/nights where my self-esteem sinks very low...usually caused by some interpersonal conflict. I get very depressed and feel worthless. I make a vow that in the morning I'm going to go back to strict dieting. I think this is less about being thin though and more about feeling self-destructive and needing a sense of control.

Fortunately, in the morning I usually come to my senses and eat normally.

When I first came to terms with my eating disorder--around the spring of 2007, I emailed my family about all of it. I told them about how I now know I had an eating disorder and I'm going to stop the negative behaviors. I expected to get sympathy, concern, and kudos for wanting to overcome my problem. That is not what happened. One of my brother-in-laws didn't believe I had a disorder and told me that. He told me I was just very dedicated. That's all it was. I put my mind to something... a goal and I achieve it. During the ED times, he'd frequently ask me how much weight I had lost. He was so impressed and gave me a lot of attention over this.

My dad showed no concern or regret for what happened to me. He merely scolded me for confessing that I had not gone to certain family outings because I had wanted to avoid food. (in the beginning I was one of those who would happily watch other people eat--even make huge desserts for others, while I ate a piece of fruit or nothing. But later this became harder for me and I sometimes avoided social events so I wouldn't have to jealously watch other people eat). Family togetherness is very important to my dad and he was horrified that I'd choose not to be with family.

After getting the email, I had shocking encounters with my family. Although I told them I was no longer dieting, they still sometimes acted as if I were At one time, we had some kind of celebration that involved cake. My BIL said not to worry. He had fruit for me! Even after I told them my problem and that I'm not on a diet any longer, he went out to get a special meal for me. I was horrified and hurt. I felt they were trying to push me back to the diet.

Another time, we were all about to have cake. My mother turned to me and said something like "Are you going to have some, or are you dieting?"

I was so disgusted that they'd say these things knowing I had an eating disorder. I would think they'd be HAPPY to see me eating.

For the past two years, I have resented their reaction...but I resent a lot about my family. For some reason, the past few weeks I've been thinking about it and wondering why they didn't give me more support.

My mom is on the Jenny Craig diet. I saw her eating a JC cake, and started thinking maybe I should go back to dieting. Maybe this one would work for me because it doesn't involve counting. I know it would be dangerous for me to do any diet where numbers are involved.

I brought it up to her in the car. I asked if she thought it was an okay diet for someone who has an eating disorder. I confess that I think I wanted to see her reaction to the eating disorder thing. After that email, we had never discussed the issue. I guess I wanted to see what she thought.

Well, I found out. She told me she didn't think I had an eating disorder. She says almost everyone goes through yo-yo dieting and if I had an eating disorder probably most women do. She asked...isn't it just as bad to keep eating and gaining weight. Isn't that a disorder?

I told her I'd rather be a few pounds overweight than have an eating disorder again.

I basically then learned she feels to have an eating disorder you have to be in the hospital close to death. She feels because I was never officially diagnosed by a doctor, and was able to gain the weight back on my own, I never had a problem in the first place. I think to her what I did back then was GOOD. The bad thing I'm doing is now--not being thin anymore.

It is really hard to struggle with something, overcome it the best that you can, and then be told you never had a problem in the first place.

I think eating disorders are unique in that instead of getting sympathy and concern....you get admiration.

When I got home from being with my mother, I cried on my husband's shoulder. We talked about the past and how neither of us knew I had a problem back then. I think he feels some guilt. He saw some old pictures of me and realized how thin I had been. He hadn't realize it back then. Then he told me about his friend (the same one who went on the fasting diet). He told me he's concerned with her because she has stopped eating. She is now a very low clothes size. She's in an emotionally abusive relationship. Her boyfriend said something like "I usually date women who are thinner than you." My husband's friend has major relationship and self-esteem issues. She obviously has serious problems. But despite knowing all this, there's this small part of me that's jealous of her. There's a small part of me that admires her.

Anyway, that's my story.

From my experience, I think family members play a big role in eating disorders. I may be going too far in saying this, but my motto is "It's hard to have an eating disorder without the support of family and friends."

I can imagine it's worse for teenagers who actually live with parents. But as an adult, I have a very troubling co-dependent relationship with my parents. They live close by and we see them frequently.

If I had advice for family and friends of people who are dieting, it would be this:

1. Know the signs of an eating disorder and know when your relative/friend is going too far.
2. Do NOT make big deals about someone's weight loss. Do not give them extra attention over this. Find other things to praise them about.
3. Do not point out that a dieting person is eating. Don't say things like "Oh, I can't believe you're eating that" or "Are you off your diet?"
4. Do not praise them for their willpower. Don't praise them for their excessive exercising or their ability to eat an apple while everyone else eats a huge sundae.
5. Do not take them shopping to award them for their weight loss. If parents do this, they should at least buy things that are a little big so the person can grow into them. Do not buy things as small as possible--giving person idea they MUST stay at this weight.

I know ultimately I'm responsible for my own health. It was my fault I had these problems and it's up to me not to return to them. But I do think certain family situations contribute to these problems. For me, it was having a family that highly values thinness, fashion, and beauty.

As a teenager and young adult, I wrote multiple novels and screenplays. My parents gave me much more attention and praise for the weight loss.

Having a skinny sibling who is clearly the favorite also contributed to that. I felt if I got down to her weight, they'd love me like they love her. And in some ways, it did work.

You know ....I think about what contributed to my recovery. I want to say it was the Livejournal visitor or my sister. But you know who probably made me come to my senses. JK Rowling. On her website, (http://www.jkrowling.com/textonly/en/extrastuff_view.cfm?id=22) she has a great essay about eating disorders. I'm a huge fan of hers and I think reading that helped me realize I was doing a bad thing not just to myself but to my son and nieces.

I started thinking what kind of message am I sending to these two little girls. They already have one very skinny aunt. What if they have two? And what if one of them is constantly dieting and exercising?

When you have an eating disorder, you're not only hurting yourself. You're hurting anyone who might see you as a role model. It's great to be a role model, but be one for something that's great. Don't be one for self-destructive behavior.

What will it take?

I write this post in sorrow and distress, after reading this story about a 57-year-old woman in the U.K. who died after 40 years of being anorexic.

It's a tragedy when anyone dies from an eating disorder, especially someone like this woman who, according to the article, died friendless, without family, alone in the world.

But the overarching tragedy here is the profound misunderstanding of anorexia expressed by the medical establishment here. While her doctor obviously cared enough about her to be checking up on her at home (he's the one who spotted her lying on the floor), he clearly doesn't get some of the most basic facts about anorexia.

Here's a quote from the story:

Discussions of her case with psychiatrists and other experts in the past had all concluded that any effort to force her to eat would only make matters worse.

"I believe that she understood the nature of her illness and its perils," Dr Knight told the inquest. "She seemed to have a very firm understanding of her condition. The anorexia was a long-term chronic condition which would not be significantly modified – she was set in her ways."

This makes me want to cry. Then scream. Then change something.

"Any effort to force her to eat would only make matters worse." Let's say a person was delusional about the act of breathing. Breathing makes you sick, they say, and they spend as much time as possible holding their breath. They have to breathe sometimes, but they do it as little as possible. Now imagine a doctor saying "Any effort to force her to breathe would only make matters worse."

I didn't think so.

When someone has been chronically ill with anorexia, their delusions are, as the doctor goes on to say, "set in their ways." But that doesn't make those delusions true. Efforts to force this poor woman to eat would have caused enormous upheaval and distress for her and likely everyone around her. That's the nature of the illness, especially when it's become chronic. (Which is why I'm a big proponent of the Maudsley approach; if you can cure anorexia while someone is still young, they often don't go on to become chronically ill. And that's why it makes me so angry when doctors still take this line with teens who are sick; don't they understand what's at stake? But I digress.)

One of the most well respected ED docs/researchers in the world, Dan le Grange, once told me that there is something about anorexia that seems to affect the people around the anorexic as well as the ill person herself. This story is a heart-breakingly good example of that kind of distorted thinking legitimized. Why is it OK for someone under a delusion like anorexia to starve herself to death? Could it be because of our messed-up ideas about body image and weight?

Here's a later quote from the doctor: "Her body image was such that she thought that she looked the right way even though to everybody else she was very, very thin."

One of the hallmarks of anorexia is an inability to see your physical body realistically. People with anorexia literally look at themselves and see oozing fat even when they're emaciated. This is one of the profound neurological distortions that we know is part of the disease even if we can't understand it yet.

So yes, this woman "liked" the way she looked. But she was in no position to "like" anything about her body, because her self perceptions were profoundly and utterly distorted.

So here's what I want you to take away from today's post:
1. People with anorexia cannot choose to get well. They need at the very least support and help from others. Often they need others to begin the recovery process for them, and stick with it for a long time, until their thinking and ideation is restored to normal.

2. There's nothing sacred about anorexia. It's a terrible, tragic illness. There is nothing glamorous about it.

3. As a society we have a responsibility to help people with this disease recover. Which doesn't include letting someone starve herself for 40 years, only to die, alone and friendless and emaciated, on her bedroom floor.

To this woman's doctor in particular I say: You meant well but you failed. And guess what? Good intentions don't count for shit. What will you do differently with your next anorexic patient?

To the rest of you, I ask that you think about this woman the next time you talk to a friend with anorexia or bulimia. And see if there's anything at all you can do to help your friend recover.

Happy No Diet Day!

Ways to celebrate:

1. Take the I-Love-My-Body pledge. Better yet, print out a few copies and leave it in public places--on subway and bus seats, tacked to bulletin boards, tucked into bathroom mirrors. (I'm working on finding a way to upload the beautiful graphic version designed by Mary Brown and will post that shortly. Blogger doesn't like my files, apparently.)

2. Eat a cupcake. Better yet, bake a dozen and hand them around.

3. Buy your very own copy of Lessons From the Fat-o-Sphere by the inimitable Kate Harding and Marianne Kirby. (If you can get it from an independent bookstore, even better!)

What are YOU doing today? Send me your no-diet-day stories.

Dear Kirstie Alley,

You seem like an intelligent person; I've admired your acting skills over the years. You seem eloquent and tuned in, except on one subject: weight.

Interviews like this one make me cringe for you and with you, Kirstie. There you are on Oprah's show, being watched by millions, most of them women, many of them, like you, beating themselves up over failed diet. How can you not know by now that it's not a question of your failure? That it's not like "falling off the wagon," as Oprah put it, but rather a basic scientific fact: Diets don't work.

Don't take my word for it. The nice researchers at UCLA did a study two years ago that showed that more than 90 percent of diets don't work--in fact, that dieters wind up gaining back all the weight and then some. Just as you did. Just as so many of us have done.

You say you feel bad because you've inspired so many people and now have let them down. I say you have an opportunity right now to inspire people in a much more meaningful way than before--you and Oprah both. You are both smart, powerful women with some of the best resources in the world at your fingertips. If you can't make your bodies look the way you want, maybe the problem isn't you. Maybe your bodies aren't meant to be size 2s or 4s. Maybe you are both tall, strong, powerful women who are built the way you're built because of genetics.

Maybe the real story here is this: What will it take to make you acknowledge your power in the world and use it for good? What will it take to help you stop wasting your time and emotions on an impossible quest?

You want to inspire other women? Try learning to love and accept yourself for who you are. Now that would be inspiring.

--From a fan

Calorie counts in college dining halls

Over on the Academy of Eating Disorders listserv, there's been a discussion going about whether it's good (or even just OK) to post calorie counts for food served on campus. I've listened with interest, and a growing sense of frustration and horror, as both researchers and clinicians debate the pros and cons.

What most of them seem to be missing--or deliberately downplaying--is the damage these calorie listings can do, not just for people with eating disorders but for everyone. And especially women. About three-quarters of women say their eating is disordered in some way, and my personal experience (for myself and watching my friends and acquaintances) certainly bears this out.

It gets right up my nose to hear the sometimes pompous arguments made by academics and researchers on an issue like this. Statements like this one: "Awareness doesn't equal obsession." Um, maybe not if you're a 40-year-old male doctor who's never had an eating issue. If you're a woman in today's culture? I beg to differ. Many years ago when I "did" Weight Watchers I was aware that eating on the WW meal plan simply replaced one food issue with another. Instead of constant anxiety about how much and what I was eating and whether I was gaining or losing weight, I became a good little obsessive weigher of foods and follower of instructions. In nine months on the program I never deviated from it once. Not even for a bite. This was a testament not to my willpower or moral virtue but to the deep level of obsession that being hyper-aware of my calorie intake inspired in me.

I'm quite sure I'm not alone in this.

Which is why I was happy to see this article, written by a senior at Yale, arguing against listing calorie counts for food served on campus.

In theory, maybe "awareness" of calories isn't a bad thing. In reality, I can't see the upside.

AED

I was looking forward to live video blogging from the Academy of Eating Disorders conference in Mexico. Alas, it was canceled due to the swine flu epidemic. A good call, but a tough one for AED. Thanks to Judy Banker and all who had to make this difficult decision.

Why Hillary Clinton should stick to talking about things she knows about

Because of obligatory and, frankly, stupid references like this one, where she compares climate change to losing weight.

I"m with you on foreign policy, Hillary. But please, do all of us women a favor and shut up already about the dieting.

**Thanks, Jane, for pointing this out to me!

Models without makeup! Or Photoshopping!

I love Bitch magazine. And I love it even more for this blog post, pointing out how this month's French Elle features models without makeup, Photoshopping, or other digital manipulations to make them look unreal.


As the Bitch blogger points out, these models are still thin, white, and have gorgeous bone structure.

Hey--at least it's a small counterbalance to the obscenely unnatural images we're bombarded with night and day. A new visual reference point.

I'll take it. For now.

Too fat to fly (but not too tall?)

My daughter took a flight recently and sat next to a man who she guessed was over seven feet tall. No lie. And because there was no elbow rest between their seats, she spent the flight hunched into a corner of her seat.

You can be damn sure this gentleman was not charged for two seats. And yet anyone who now flies United who takes up more than his or her allotted seat centimeters due to weight will be charged for two seats. So flying fat will cost you double, but flying tall won't.

I find United's new policy offensive and discriminatory on many levels. If you do too, consider following the directions in the form letter below, which was created by Marilyn Wann, to protest. Because you better believe that if United gets away with this, all the major carriers will start imposing a fat flyers' penalty. And who's to say what's "too fat" to fly with a single ticket? Down the line, could ticket agents be whipping out BMI charts when you get your boarding pass? I put nothing past this fatphobic society (and the airlines desperation to turn a profit).


Hi:

United Airlines is the last of the major carriers to announce proudly a policy of charging fat passengers double.

They say they received 700 complaints last year (out of 80 million passengers carried) from thin people who did not like having a fat person sit next to them and perhaps take up some of their seat space.

I am convinced that the 700 fat seatmates who didn't complain were not too happy about the situation, either. People in the fat pride community have decided to try and beat that 700 complaints statistic.

I'm writing to ask you and the people you know to complain at United.com about this costly and discriminatory targeting of one demographic group. If this policy stands, it means fat people have less right to interstate air travel than other people. Everybody deserves a safe and comfortable chair on an airplane, at an affordable price!

Here's the link for Customer Relations.

Expect to be asked to fill in some irksome required fields:
- If you don't have a United frequent flier number, you can use mine: 00229870823.
- For flight info, I just put 4/15/2009 (the day United announced its policy).
- For departure and return cities, I put San Francisco in both slots.

Please copy your complaint letter to my e-mail address, so we can keep count as we approach and pass 700.

Thanks tons! - [insert your name and e-mail address]

--Marilyn

I cried

This video has gone viral*, so you've probably seen it already. If you haven't, watch it now.

If you have, maybe you had the same reaction to it that I did. Watching this video made me bawl. Not a polite little trickle of tears but a full-blown sobbing meltdown.

It's not just because Susan Boyle has an amazing voice, though she does. It's not just because the poshly hateful judges on the U.K.'s version of American Idol got their expectations upset, though they did, and I was thrilled about it.

It's because this video highlights--painfully, vividly, undeniably--just how far our obsession with appearance extends, and how much we punish one another and ourselves for how we look.

Watching this reminded me all too viscerally of how I felt about myself as a teenager and young woman: Unattractive, and ashamed of it. Hideous outside and, therefore, inside too. I've grown up since then, thank goodness. I've made peace with myself both inside and out. I no longer feel hideously unattractive (though there are moments). Most of all, I think--I hope--I've learned to temper my own judgmentalism about other people based on how they look.

I cried partly in awe of Susan Boyle's sassy spirit. She didn't creep onto that stage; she took it over. I love how she blows kisses at the audience on her way out--she might have given them all the finger, but she's much classier than that.

Do yourself a favor. Give this a look. Think about it.

*Normally I would have embedded the video, but YouTube is preventing it from being embedded. I wonder why.

Develop your inner skeptic

I love this little critical thinking project, created by a guy named Frank Baker who has made it his mission to teach young people (and us old people, too) to think more critically about media messages. Baker put together a fabulous page of links to diet and weight-loss ads to help teachers show kids just how manipulative, treacherous, and false such ads can be. Very cool. He also gives some background on how the Federal Trade Commission's guidelines for ads like these. Which, frankly, shocked me, though it shouldn't have. But somehow I am always surprised when people acknowledge they're lying.

Take a little cruise through the site and you'll wonder why we tolerate deceptive advertising like this. Baker's point is that it's our job to read between the lines and become better media critics--a conclusion I agree with whole-heartedly. (But these ads still piss me off.) I plan to find a way to bring this into some of my classes next year.

Nice going, Frank!

Remember days like this?

Wishing you all a happy holiday and a return to the innocent enjoyment of food that tastes good enough to really get into.

Argh!

This is exactly the kind of story that makes me wish the New York Times really would close the Boston Globe, as they've been threatening. Not to blame the messenger or anything.

But come on--has it really come to this? This fall, Massachusetts schools will send home "weight reports" with students in first, fourth, seventh, and tenth grades, which will, according to this story, alert parents "if their child weighs to much or too little."

Multiple levels of Argh! apply here. Too much or too little according to whom? Will this be another episode in the Annals of Administrators Acting as Doctors? Who, exactly, will become the Weight Police?

Authorities in Mass. promise that the new reports will "provide suggestions on where to turn for help." I'd love to see them. No, wait, I've already seen them! Because there's nothing concrete or new here. We can predict that the state's suggestions on how to "help" kids who weigh "too much" will not be helpful at all, because, um, read the news, people--we don't know how to make people thinner. Even if we all agreed that everyone should weigh a certain weight, we haven't the faintest idea on how to get them to weigh that for more than a month or two.

Have these folks not seen the research on how dieting makes you fatter? Do they think they know something the rest of us don't know?

The geniuses behind this legislation dismiss worries that the new mandate will trigger eating disorders. That's pretty ignorant. I'm guessing they have no idea how toxic the dialogue gets around food and weight, especially in middle school. My 8th grader tells me that body bashing is "a bonding experience" among the girls in her class; if you don't join in, you're not one of the group. Swell. I think a mandate like this will really help, don't you?

Please go to the article and leave a comment. Please, if you live in Massachusetts, write to your legislators. (Here's a list with links.) Let your voice be heard on this one.

When meds make you fat, part 2

I don't know how I missed it, but this week's New York Times "Well" column covers the same territory as my last post.

Head on over there, if you haven't already, and add your comments to the mix. You'll find a few that make you want to bang your head, but more that are genuinely confused and curious. They could use your expertise. :)

Full

Lunch today was a delicious salad nicoise, not unlike the one pictured here. I ate nearly all of it, stopping because I was full.

Why am I telling you this? Because it's been about 7 months since I have eaten and felt full. Not because I'm starving myself but because I've been taking an anti-depressant that messes with my metabolism. I knew it would have this effect. I knew this intellectually, but still, over the last few months, I've struggled with various kinds of fallout from never feeling full.

You eat more when you don't feel full. Especially if you are, like me, a person who likes food and likes to eat. Normally food stops tasting good as you begin to feel full. But if you never feel full, the food keeps right on tasting good, and it's an effort of will and intellect to stop eating.

I say that I knew this medication would have this effect. What I actually mean is that I think it has this effect on me (and on others). But part of me didn't buy it. On some level I've been flagellating myself for the last few months for eating so much and never feeling satisfied.

We do such a good job in this culture of conflating appetite with gluttony, with greed, with being out of control in a scary way; I don't know if it's possible to think of appetite in neutral terms. Certainly it isn't for me. Certainly it's been tough to say to myself, "The little thingy in my brain that signals satiety is not working right now." Much easier to say to myself, "What a greedy, insatiable fill in the blank I am."

So along with that feeling of fullness today came another feeling: relief. It feels good to feel full. It's satisfying.

But it's disturbing to feel this kind of relief. I may very well have to back on this medication, or one like it, in the not too distant future. Part of me says unh-unh, never doing that again, I don't care what the consequences are. But is that really true? Would I rather be thinner and more depressed? Thinner and more anxious?

The questions make me think back to this study, which found that people would rather give up years of their life, be severely depressed, lose a limb, go blind, be unable to have children, if they could only be thin.

I think of myself as smarter than that. And yet--it feels good to be full again.

Listen up

A few weeks ago I did a radio interview for a show called "A Touch of Grey." You can now hear the interview online here. (Scroll down to "Harriet Brown.")

If you haven't written an Amazon review of Feed Me! yet, I'd love it if you would. (Even if you didn't like the book.)

Happy spring!

Al has ham. Al is a fat cat. As is a sad fat cat.

Thanks to blog reader Joan M. for sending me the following:
I have a 5 year old and I am teaching her to read. I have a program made by a company called Frontline Phonics. They have a book called "Ham and Jam": Al is a cat (happy smiling cat), Al has ham (happy cat eating), Al has jam (happy cat eating), Al has ham and jam, Al is a fat cat (cat now has distended belly and is frowning), Al is a sad fat cat, Al ran. Al ran and ran. (cat on the treadmill) Al is a cat. (happy thin cat again)

And the questions that the parents are suppossed to ask after they have read the book are: What made Al so fat? What did Al eat first? What did Al do to become thin again? Why is Al smiling?

Talk about teaching kids while they are young to associate fat and sadness and thin with being happy.

Let's tell the story another way:

Harriet is a blogger. Harriet reads about books like this. Harriet feels sad. Harriet feels mad! Harriet's head feels like it might explode. Harriet swears at the screen. Bad screen. Bad books. Bad thinking.

Any of you come across similarly egregious books aimed at early readers? Inquiring minds want to know.

Kudos to Salon and Kate Harding

for this piece on the new study just out from England that may finally shut down the "Anorexia is the mother's fault!" argument. (You have to register on the site to see it, but you can get a free day pass.)

The study looks at brain development in utero, and reinforces the notion that genetics and neurobiology are the biggest culprits when it comes to why some kids develop eating disorders. As Harding writes:

Ian Frampton, a pediatric psychology consultant and co-author of a study to be presented at a conference at the Institute of Education in London this week, says, "Our research shows that certain kids' brains develop in such a way that makes them more vulnerable to the more commonly known risk factors for eating disorders, such as the size-zero debate, media representations of very skinny women and bad parents." The Guardian reports that based on "in-depth neuropsychological testing" on over 200 anorexia patients in the UK, US, and Norway, Frampton and his colleagues found "about 70% of the patients had suffered damage to their neurotransmitters, which help brain cells communicate with each other, had undergone subtle changes in the structure of their brains, or both." In the past, researchers often assumed that anorexia causes changes to sufferers' brains, but these findings suggest that it works the other way around.

One caveat: If you value your sanity, don't read the comments. Unless a huge surge of adrenaline would be a positive development in your evening.

*Full disclosure: Harding mentions Feed Me! in the piece. Thanks, Kate!

Help for bulimia

I know from personal experience how family-based treatment (FBT, also known as the Maudsley approach) can work in treating anorexia. I'm thrilled that the evidence is mounting for its effectiveness with bulimia, too, especially for teens with bulimia.

But don't take it from me! Maudsley Parents has been putting together information on bulimia and its treatment, which you can see here.

Both Stanford University (where Dr. Lock teaches and researchers) and the University of Chicago (where Dr. le Grange is based) are recruiting teens for bulimia studies right now.

Here's a video of Dr. James Lock, who literally wrote the books (along with Daniel le Grange) in the U.S. on FBT, talking about bulimia:

Rant ho

Now that we bloggers have come to represent the new media, we get a lot of the same kinds of PR stuff that used to go to newspapers and magazines--press releases about new products, upcoming events, etc. Occasionally I find something of interest.

More often, I cannot believe someone sent whatever it is my way. Take, for instance, the email I got today. Subject line (cue drumroll):

Could the Recession Be Making Us Fat?

Gee, I thought we were already too fat--in the midst of an obesity crisis, as a matter of fact. The recession's only been around a year at most. So, I don't know, no?

The email goes on with predictable idiocy to quote a nutritionist saying that in "uncertain times," people "crave rich foods." That's merely banal. The truly enraging part comes next:

"Eating disorders like anorexia nervosa and bulimia are also on the rise. "

Since the prevalence of anorexia and bulimia has been pretty constant for as long as we've been diagnosing them (about 1 percent for anorexia, 2 to 3 percent for bulimia), I'd love to know where this nutritionist is getting this shocking new information. Maybe from the bullshit fairy?

The journalist in me recognizes what we call "fudging" when I hear it, and this is pure fudge--the kind of unsupported generalization people offer up and that too many people believe because, um, it sounds like the fudger knows what he's talking about.

And here's the kicker:

"Both illnesses are tied to stress, depression and the need for control, which is a direct link to the sentiment of many Americans during this recession."

Oh really? Notice the fudging language here? EDs are "tied to" stress and depression. They sure are. So is cancer and heart disease. And then we get the twist of the knife--that old "need for control" crap that's been trotted out routinely ever since Hilde Bruch started writing about anorexia.

The whole thing is actually shopping this unnamed nutritionist as an authority on--wait for it--losing weight.

Yeah, this guy is a real authority, all right.

Note to PR flacks: Do the research before you send out crap like this. You're doing your clients way more harm than good.

Next time I'm naming names.

Just because you're paranoid doesn't mean they're not out to get you

The world of eating disorders treatment is changing. Slowly. Infinitesimally. Minusculely. But change is creeping in.

Still, most ED patients and their families get smacked upside the head at some point with the old assumptions and stigmas about these illnesses.

Such as: Eating disorders are caused by cold or overcontrolling mothers; the child has no other way to establish a sense of autonomy, so she stops eating.

To their credit, many docs have left this one behind. Some say they've left it behind but still on some level believe it. And now I have an inkling into why: A friend who's in med school, and who just finished the hour or two devoted to talking about eating disorders in the curriculum, reports that this outdated and discredited point of view is still in the textbooks.

So on some level, these stigmas are still being perpetuated. Big surprise, I know. But you know, it was a surprise. I'm enough of a good girl academically that reading something in a book makes it shiny and important.

I feel pissed off and sad, though, at the thought that this kind of perspective is still living out there in print, for new generations of baby docs to read and take in. Especially since most of them get almost no training in treating eating disorders anyway. So this might be all they take away from med school on the subject. And it's wrong.

Of food revolutions and politics

This article in today's New York Times poses the question of whether the time is right at last for a revolution in the way we grow, buy, distribute, and eat food. A perfect storm of factors, argues the writer, is brewing to make this happen: Economic hardship, political leaders who value sustainability and an older-school farming ethos, and an ever-more-complex web of relationships between those who grow food and those who eat it.

Is it, as Michael Pollan has suggested, time for a reform of our entire food system? Is this the moment to move toward the Alice Waters model of growing and eating local? I hope so.




The agribusiness lobby has had Washington's ear for the last eight years. I hope the new administration can hear something else now--the concerns of small family farmers, organic farmers, parents who want to feed their children (and eat themselves) high-quality food. One of the biggest obstacles to meaningful food reform in this country has been the fact that only the relatively wealthy have access to good food. So I'd like to see policies that broaden that access and make it possible for poor and inner-city consumers to buy local fruits and veggies, organic meats, and food that's grown to taste good rather than to last 4 weeks in a crate on the back of a truck.

Why am I writing about this here, you might ask? Because eating local food, organic food, food that bloody well tastes good, is a crucial part of learning once more to celebrate and enjoy food. It's a back door into my obsession with the joys of eating and of being comfortable with your body.

OT: The Hebrew Mamita, Yo

Def poetry and you don't look Jewish. Rock it.

Here's one little gizmo I won't be buying

The HappyHR (I kid you not) continuously calculates the amount of calories you burn. Even, um, when you're asleep.

"Stay fit and be happy" is the slogan dreamed up by the Georgia Tech students who are building this gadget. I think they've got the wrong slogan there. How about "Think you're obsessive about eating now? Wait till you wear one of these babies."

I can already imagine the new eating disorder that will grow out of this. Calorexia, anyone?

If the U.S. were my students, they'd flunk

The National Alliance on Mental Illness recently released a report card on America's health care system for adults with mental illness. Our grade: D.

At the Newhouse School of Public Communications, where I teach, this is a failing grade. We flunk when it comes to creating a support system for people with mental illness. We have no network of consistent services, no consistent access to mental health care, and no standardized system of licensing or treatment criteria.

We fail in other ways, too. We as a society fail to take seriously the ravages of mental illness. We step over those with mental illness both literally and figuratively. We turn our faces away. We perpetuate the shame and stigma of diseases like schizophrenia, bipolar disorder, and, yes, eating disorders.*

My students always want to know how they can raise their grades. I put the same question to all of you: How can we as a society raise our grades when it comes to mental illness?

Here's my two cents on the subject:
1. Offer incentives to those studying to be doctors and therapists. One reason we have such a staggering lack of good mental health providers is that in our current health-care system (or shall we say lack of health-care system) they can't earn as much as other docs. This is partly a function of how our disgraceful so-called health insurance system works. See 2.
2. Mental health parity is a good first step, but it's full of loopholes. Enact legislation that prevents health insurers from weaseling out of covering mental health issues. The track record is dismal, especially for eating disorders.
3. The first two items on the list would start us on the road toward lessing stigma around mental health issues. Shame on the health insurers for heaping more shame, and financial burden, on families struggling with these issues.
4. Talk, talk, and more talk. The more we talk about a subject, the less shameful it becomes. Social change takes time. Let's get started.

What are your ideas?





* I'm not a believer in classifying eating disorders as mental illnesses, but for now that's where they reside and so that's where we've got to live with them.

A challenge to my readers

A front page article in yesterday's New York Times made me weep. (I've chosen not to upload the photo that ran with it because it is so very distressing. But please read the article.) It's one of the things I love most about journalism: Its ability to shake readers up and make a story personal. Agenda-setting, we call it--telling readers not what to think but what to think about.

I know that children around the world are hungry. But somehow this one image and story brought home the issue vividly and powerfully.

There are children right here in the U.S. who are this hungry, of course. Probably right in your hometown--no matter where you live.

So here's my challenge for the day: I'd like those of my readers who can afford it to make a donation--no matter how small--to an organization somewhere in the world that feeds children. It could be the U.N.'s World Food Programme, which is working in India. It could be Feeding America (which used to be called America's Second Harvest), which addresses hunger here at home. It could be Mazon, a national nonprofit agency that describes itself as a Jewish response to hunger, or any one of dozens of other anti-hunger organizations.

Give money if you can. Bring a can of soup to your local food pantry if you can't. But do something--today. And then please check back in and let us know what you've done.

Put your money where your heart is . . .

and consider making a donation to the Academy of Eating Disorders' 2009 scholarship campaign.

One of the sad truths in the field of eating disorders is that there just isn't enough research being done. That's one reason for the relatively ineffective treatments we've got--there's not a lot of money to be made by researching EDs, probably because pharmaceuticals don't typically do much to help. So researchers--especially young researchers--have to find other ways to support their work.

One of the things I really like about the AED as an organization is the ways in which it nurtures research. And this is one of them. Since 2002, the scholarship fund has helped fund more than 50 clinicians and researchers from around the world to work on finding solutions for eating disorders. It's a worthy cause--and tax-deductible, too!

Dietitians and fat bias

This study, which shows that dietitians (like doctors) suffer from a significant amount of fat phobia, does not surprise me. Why should dietitians be different from any other group of medial professionals?

One or two sessions with a dietitian is really all it takes to learn the necessaries on nutrition for someone recovering from an ED. Yet our family--like so many others--was told to make weekly appointments with a nutritionist.

As it happens, the nutritionist we saw was not fatphobic; she was just ignorant about how to talk to my daughter. In fact she was a very tall and large woman who told Kitty, at our one and only appointment, "Don't worry, honey. I used to have an eating disorder too, and look at me now."

It was almost funny, really, except that it took hours of reassurance to get my daughter back on track.

Which is why I like to talk to medical professionals--not just about eating disorders but about attitudes toward fat, obesity, and "wellness" curricula in schools.

So if you know of a group of doctors, nurses, nutritionist, or other medical professionals in training or in practice who could benefit from a talk, let me know.

Sadly, this is very funny

Bratz Dolls May Give Young Girls Unrealistic Expectations Of Head SizeThanks to Jane for linking me to this hilarious (and thought-provoking) video satire from the folks who bring you the Onion.

What I want to know is how the actors pulled off their lines with straight faces.

Or maybe it's not that far off the truth. . . .

Looking for women with autoimmune disorders, PCOS, lupus, IBS, fibromyalgia, chronic fatigue for a story

I'm doing a story for HEALTH magazine on diseases that a) disproportionately affect women and b) have historically been unrecognized, under-treated, or generally pooh-poohed by the medical establishment, but are now being recognized and/or taken more seriously. I'd like to tell several personal stories as part of the bigger piece.

So if you have had or still have any of the conditions above, or anything similar, and would be willing to let me interview you and possibly tell your story for the piece, please email me at hnbrown at syr dot edu.

Many thanks.

Seeing red

As a professor of journalism, I read a lot of media. And some days, what I read makes me feel downright ashamed of my industry. Today is one of those day, and the triggering story is this one, from the Washington Post.

The piece is written by a young woman who discusses the power of a parent's words to trigger an eating disorder. I have nothing against the writer; it's a heartfelt and I'm sure honest piece of writing. The writer attributes her three-year course of bulimia to a critical comment about her weight from her mother. The piece goes on to list "resources" for parents, presumably to prevent them from doing such things in the future.

I'm not defending this mother's comment. Far from it. I grew up in a family where comments like these were fairly commonplace; I know how hurtful they can be. My problem is with the editors of the Post, who did not do their homework. They accept this premise as if it were 100% true and present no other point of view. There's nothing in the story to contradict the notion that a parent's comment can in fact trigger an eating disorder. There's nothing on the heritability or biological roots of eating disorders, on the neurochemistry of starvation and purging. Readers are left with the sense that a stray comment, especially from a mother (always the mother), can cause the nightmare of an eating disorder.

Had the editors of the Post looked at any of the recent research on eating disorders, they might have been inspired to add another perspective to this young woman's story. Had they stopped to think about it they might have realized that if a parent's words were truly that dangerous, we'd have many more cases of eating disorders to contend with (because God knows parents say hurtful, stupid things all the time, myself included).

The irony is that this piece ran in a package along with an excellent piece written by Carrie Arnold, whose blog Ed-Bites and books are both well-researched and moving. Arnold's piece is informative, but its headline and deck--"Extreme Measures: When Kids' Size Is a Problem, Parents Seek New Solutions"--written by the editors, are misleading, possibly deliberately so. Since when are anorexia and bulimia a problem of a child's size? Hello, do the editors here know anything at all about eating disorders? Do they not care? This kind of thing perpetuates the destructive myths around eating disorders--that they are "about" appearance, that they aren't serious health issues, that they happen only to the children of overinvolved and overcritical parents.

Fact: Eating disorders happen in all kinds of families--rich, poor, white, black, Latino, overinvolved, neglectful, respectful, authoritarian, authoritative, permissive, large, small, functional, dysfunctional.
Fact: Eating disorders are complex and multifactorial. We don't understand their origins. We do understand that blaming parents is both unhelpful and unhealthy--and often untrue.
Fact: The family is almost always a child's best chance at recovery.

The Washington Post's concept of families seems about as outdated--and harmful--as the photo above.

I shouldn't be seeing red right now. I should be used to this. Somehow I never get used to it.

Cupcakes and conversation

If you're anywhere near Syracuse, NY, this Thursday, please stop over at the panel discussion and book signing for Feed Me!. The book includes fabulous essays from some of my favorite writers, including Joyce Maynard (whose poignant memoir about making pie with, and then for, her mother still makes me tear up), Caroline Leavitt (who wrote a haunting piece about men, power, grief, and food), Diana Abu-Jaber (writing about the culture clash between Bedouin and American eating habits), and many others.

We'll hold a panel discussion with Mary Tantillo of the University of Rochester's Eating Disorders Program and Cris Haltom of Ithaca, both of whom speak eloquently about food, eating, and related issues. And yes, there will be cupcakes. I'm not saying they'll live up to the perky frosting on this one, but, you know, a cupcake's as good a reason as any to come out on a chilly night.

If you don't show up, I'll have to eat all the cupcakes myself.

The stigma of mental illness

This piece, from my local paper, is both horrifying and provocative. The writer, Joyce Gramza, tells how her daughter, who has paranoid schizophrenia, was punished--in the hospital, awaiting transfer to a residential facility--because of her illness. It's an upsetting story.

What's even worse, as Gramza goes on to catalogue, is that her daughter's case is not an anomaly. Rather, it reflects a level of proven prejudice among doctors, nurses, and other medical professionals. Even for those who should know better, it seems, the stigma of having a mental illness can diminish the level of care, both physical and psychological.

An old friend of mine had a brother who was schizophrenic. I knew Steven as a talented musician whose dreams of becoming a composer never materialized but who made a life for himself despite his illness. Steven was in his 40s and receiving treatment for colon cancer when he died. The autopsy showed that he had literally no white blood cells left. The chemo that was supposed to help him killed him, because no one had monitored his white cell count.

Might this have happened to a patient who was not schizophrenic? Sure. But it happened to Steven. And he was not alone. The studies Gramza cites demonstrate that this kind of dropping the ball on care happens to a lot of mentally ill patients.

My hope is that more people will advocate for their mentally ill loved ones, whether the issue at hand is a mattress to sleep on or proper bloodwork. In the middle ages, people feared that they could catch mental illness from touching someone who had it. Our attitudes today, sadly, have not evolved very much.

Write a review?

Hey y'all, I'd love to see a couple more customer reviews of Feed Me! up on the Amazon site. (Good ones are preferable, but say what you really think.) Would you consider sending one in for me? It doesn't have to be long or fancy--just whether you liked the book and why.

Thanks. Really.

Join the Rebellyon

Thanks to my friend Erik for sending me a link to this story about musician Amanda Palmer, whose record label, Roadrunner, told her that her stomach looked too fat in a new music video and that they needed to digitally slim it down.

Palmer's response: Love thy belly. Her fans jumped on the belly wagon, creating a "rebellyon" that includes a website where you can upload a photo of your own belly, inscribed with a message to the world.

This story is interesting both for its element of cultural body dissing and for its feminist subtext: Apparently one of the record label execs told Palmer, "I'm a guy. I know what people like."

Yeah, I'm a woman. I don't know what people like. I don't know what my own body looks like. And I sure as hell don't know why I'd ever buy another Roadrunner record. Except, of course, for Palmer's latest.