Warning: The Images You Are About to See May Be Damaging to Your Health

I'm a big fan of Jezebel, but I think they've got it wrong this morning. In a post discussing a recent editorial in the Daily Mail by grieving mother Rosalind Ponomarenko-Jones, whose 19-year-old daughter died of anorexia, Margaret Hartmann argues against the notion of labeling photos of celebrity "twiglets" when they get too thin.

Ponomarenko-Jones argues against the current appearance-driven culture, which calls out celebrities not for achievements but for appearance. And "calls out" is the right expression, since we're all familiar with the standard scary-skinny-celebrity story these days: Publish a photo of a woman so emaciated that it's painful to look at her, along with a headline that screams a fake concern for her well-being. The whole exercise feels prurient and voyeuristic.

Hartmann centers her argument on the logistics and legality of the question: How would we determine when a celeb is "too thin"? How would we know when to label an image and when not to? It's a valid point. And before commenters jump on me for this, I acknowledge that you can't tell whether someone has an eating disorder just by looking at her. Some people are naturally skinny, and there are other reasons (other illnesses) for gauntness.

But Ponomarenko-Jones has the moral high ground here, and I wish there were a way to honor the spirit of her request. Because we (and by "we" I mean the media) don't go around publishing photos of, say, recent cancer victims, who may be every bit as scarily skinny as an actress in the grip of anorexia. Yet magazines and websites are full of images of "twiglets," young women so thin you can see the shape of their femurs. Why is it OK to publish these images and not, say, images of Farah Fawcett as she lay dying of cancer?

It comes down to our blindness to eating disorders as "real" diseases. We would cringe at the idea of violating Fawcett's privacy in that way. Yet the young celebrities who walk so scary-skinny among us are dying of an illness, too, an illness that will kill them as surely as cancer killed Fawcett. The difference is that with treatment, many of these women can recover; for Fawcett and many other cancer victims, alas, treatment did not save their lives.


And of course treatment won't always help with eating disorders, either. But the point here is that instead of parading these images as models for women--whether this is openly acknowledged or not--we should label them for what they are: images of the gravely ill, who are struggling with their own terrible reality and heart-breaking health battles.


Jezebel got it wrong. The real shanda (as my grandmother would have said) is that we pretend there's no such thing as too thin.

Conference in Chicago--register now!

In just over two weeks Maudsley Parents will sponsor its second conference on eating disorders--this time in Chicago. This one-day conference, aimed at parents, therapists, and researchers, features some of the best thinkers on eating disorders in the country--including Dr. Daniel le Grange and Dr. Walter Kaye—plus a panel of parents who will talk frankly about what they know about combating their children's eating disorders.

It's going to be a fabulous event. I'll be there, along with my two partners in crime from Maudsley Parents--Jane Cawley and Ann Farine. We've worked hard to keep it affordable so everyone who wants to come can manage it.

For more information or to register, click here. We'd love to see you in Chicago!

Book Giveaway: 100 Questions & Answers About Anorexia Nervosa

Dr. Sari Shepphird is one of my favorite "experts." Shepphird, a clinical psychologist from Los Angeles who specializes in treating eating disorders, has a new book out, 100 Questions & Answers About Anorexia Nervosa. The book tackles the complex and confusing subject of eating disorders by posing and answering questions like "Are athletes at greater risk for developing anorexia and eating disorders" and "How do I know if I have a healthy body image?" The book is written for people with anorexia, their friends and families. I admire its clear, practical approach, and think it will be of great help to many.

And I've got a copy to give away! If you'd like to enter the drawing for a free copy of Dr. Shepphird's new book, leave a comment on this post telling me why you're interested in reading it. I'll draw names at random next Monday, March 29.

Good luck!

A troll among many trolls

I don't normally bother with trolls, but this one sent me an email to my work address that is so vile, I have to share it here with all of you.

Barry, I suspect you are what I think of as a self-loather. Maybe you were once fat. Maybe you're fat now. Maybe you're deathly afraid you will be fat in the future.

Personally, I love how you toss aside research in favor of your own baseless and warped opinions. That Barry, he sure knows better than those high-falutin' doctors who actually research this stuff!

Since you think shame is a good health-care strategy, I'll take your idea a step further and see if shame is a good strategy for curing haters like you. Probably not, alas.

I hope my readers will respond to you in the same spirit in which you wrote to me.



I was mystified and angered by your article in the Times today. Are you actually arguing that obesity is a healthy lifestyle? Are you really saying that fat people have no control over their food intake and amount of exercise? Eating too much is nothing to be proud of, just as drinking too much alcohol is nothing to celebrate. You are lying to yourself if you think you are not shoving far too many calories into your mouth. You're fat because you can't control yourself--it's that simple.

The reason we stigmatize obesity is because it really is a choice, unlike skin color, ethnicity and the religion you were raised in. Obesity is a signal to others that this fat person is living an important part of his/her life totally out of control. It signals a lack of self-discipline and a warped sense of self-worth. Your position on this means means you're proud of your lack of control about how much, and what, you eat. It's delusional to be proud and pleased that you are out of breath when you climb stairs, that you are heading for a horrible old age--if you live that long, that making love to your partner is a problem instead of a happy event, and that you can't perform simple tasks from properly wiping your ass on the toilet to picking up an earring you've dropped.

Delusional: For example, you state that the emotional stress of the prejudice against fat people causes the health issues that result from obesity. That is not science, that is nonsense. We know stress can be a contributing factor to poor health, but you're trying to blame others for the conditions you create by eating too much. Reminds me of alcoholics saying they drink too much because of all the pressure on them to stop drinking.

On the one hand you blame doctors for relating to obese people differently than normal weight folks because, as you say, doctors believe fat patients won't follow orders, won't show up for appointments etc. Then later in your article you say fat people don't show up for doctor appointments because they feel bad about themselves and worry about how doctors will relate to them. Doctors know from experience that fat people miss appointments and can't or won't take care of their own health. Of course they relate differently to people like you who disdain main stream medical advice.

When Lincoln University tried to help fat kids get well and avoid incipient heart and other diseases, you condemn them for their efforts. What you fail to understand is that your stance actually kills people by making gluttony and self abuse through food a good choice, a choice to be proud of. What you are doing diminishes the real harm of prejudice which punishes innocent people for the color of their skin or their ethnicity--things they can't and should not want to change.

But obesity is a lifestyle choice, like smoking and alcoholism, a self-destructive lifestyle choice that harms the people who choose to follow that course. Anyone can get thinner and improve their overall health. It is not easy but rarely are the important life choices easy. That doesn't make your choice a virtue. It is difficult to diet and exercise on a regular basis and change your attitude about stuffing as much food as you can into your face. We've all heard the reasons people live your way, and none of them are good, abuse as a child, the comfort derived from eating lots of fatty creamy things, the hit of sugar, the bad habits of a deprived upbringing blah blah blah. We rightfully despise drunks who abuse themselves and others, ruin careers and the lives of those who love them. Similarly obese people are wearing a big sign that says "it's all about me and screw you who object to my overeating, it's costs to society, it's bad example to young people, it's strong signal that I'm out of control. I do it because it feels good and I'm proud of that." This is called selfish and irresponsible--nothing to be proud of.

Think about the damage your article has done. Making a virtue out of a lifestyle that any scientist, medical person or just plain educated folks know is harmful. Shame on you.
Barry XXXX
NY

PLEASE NOTE: THIS THREAD IS NOW CLOSED.

The stigma of obesity

I'm delighted that the New York Times has run this piece, even though they cut the fabulous Marilyn Wann from my final draft.

Let me know what you think. And if you're feeling brave, venture on over to the New York Times' blog discussion of it. It's a stunning example of how deeply ingrained fat stigma is in our culture. Sheesh.

And a big welcome to Jezzies who land here. Love the photo of Gabby that ran with the post today.

Protest in D.C. today

If you're in Washington, D.C., today, check out this protest against the insurance industry. Activists plan to "arrest" health insurance execs who are there for a meeting, and hold a rally afterward.

The idea behind the event, according to Gerald McEntee, president of the American Federation of State, County, and Municipal Employees (AFSCME), is "to expose the high crimes and misdemeanors perpetuated by the insurance industry time after time and year after year, and we are totally sick of it. We're going to crash their party and put an end to its injustice."

I'm with you in spirit!

The U.K. tackles body image issues

Kudos to the Royal College of Psychiatrists across the pond for taking on the thorny issue of media and body image in a powerful way.

The U.K. group just issued a statement admonishing the media for their damaging portrayal of eating disorders. That's good, and it goes along with similar statements made recently by several U. S. groups. Raising awareness on both sides of the pond--excellent work.

The RCC's gone a step further, though, calling for a "new editorial code" that would end the promotion of the unattainable thin ideal in the media. This is a bold step, and I'm going to be following developments closely on this subject.

The RCC identified three main areas of concern (and I'm quoting here from its press release, as you can no doubt tell from the Anglicized spelling):

Visual imagery: Preteen or underweight models are used by the media and advertising companies to promote a thin body ideal, and airbrushing and digital enhancement is widely used to portray physical perfection that is unattainable in real life.

Unbalanced articles : Many magazine articles give advice on dieting without giving information about the long-term effectiveness of diets and the dangers of extreme dieting. ‘Body critical’ articles also target celebrities for being overweight, underweight or physically imperfect, which normalises body criticism and can make people dissatisfied with their own bodies.

Inaccurate portrayal of eating disorders: Many articles ‘glamorise’ weight loss and portray eating disorders as mild disorders or personal weaknesses, rather than serious mental illnesses requiring specialist treatment.

I'm expecting cries of First Amendment foul on this side of the pond. It raises an interesting dilemma for me, as both a magazine journalist (and professor of magazine journalism) and an eating disorders advocate. Is censorship ever a good idea? How about self-censorship, which I think is what the British shrinks are suggesting?

My journalism colleagues will no doubt want to throw me off the island for saying this, but I'm all for some kind of self-censorship in this case. No journalistic standards will be violated if, for instance, magazines ran images of beautiful 20-year-old American models instead of emaciated Russian preteens with preternaturally pouty lips. In fact, I could argue that in the best possible tradition of journalism, magazines have a responsibility to tell both sides of the story: Instead of blaring the trumpets of weight loss at any cost, how about stories that encourage women to accept and love themselves as they are? I'm not even gonna mention the kind of cognitive dissonance that comes from Photoshopping the hell out of Kelly Clarkson on the cover and then running a feature quoting her as saying she loves her body the way it is and doesn't feel the need to diet herself into oblivion. I'm not even going to mention the magazine that did this (cough, rhymes with elf).

When I pitched a story on self-acceptance and body image recently to a magazine that shall not be named (cough, rhymes with wealth), I was told by my editor, rather sadly, that it would never fly.

Maybe when pigs grow wings.

**Thanks to one of my students, Courtney Egleston, for posting this story originally on the Newhouse magazine feed.

Jezebel investigates MeMe Roth!

Check out this awesome post by Jenna over at Jezebel, who as far as I can tell is the only journalist who's actually bothered to investigate Roth's pseudo (cough fake) credentials for her ridiculous one-woman anti-obesity campaign.

As a professor of journalism and writer for mainstream media outlets, I'd love to know why no one else has even questioned Roth's patently false claims and unsupported stance. How about Nightline, which pitted Roth and a chick named Kim Bensen against Marianne Kirby and Crystal Renn in this "faceoff" questioning "Is it OK to be fat?"

I can't help but think this is a) an example of how sloppy some journalists are getting, and b) a function of the widespread fatphobia washing through the culture.

Either way, kudos to Jezebel for doing some actual reporting. And, of course, presenting that reportage with the requisite levels of snark and sarcasm.

The Woman at the Y, part 4

She was back again. The woman at the Y. I thought I was ready. I'd talked to myself about it. I'd told myself, It's her business, it's her life, I don't know her story, and anyway, there's nothing I can do. So when she took up a position right toward the back of the room this morning, I made myself look away from her in the mirror. I did OK.

But five minutes later, I looked at the mirror and she had somehow moved up in the class. She was now directly behind me, close enough to once more see the shape of her thigh bones through her pants, see the strained and straining look on her face. When the song ended I moved across the room, to a spot where I couldn't easily see her. I thought I was doing OK.

And she took off her shirt.

Understand, this is not a class where people take off their shirts or exercise in their sports bras. I've never seen anyone else do that. Not that there's anything offensive about the idea of working out in a sports bra; it's just not the culture of this particular class. So her action would have been startling no matter who she was or what she looked like.

Now everyone could see the shape of every rib, count the knobs of her spine, consider the impossibly small diameter of her waist.

I fled. I ran out of the room clutching my water bottle and sat in the bathroom of the Y and cried.

I'm sure at this point that she knows that her presence disturbs me. As a friend later said, it's as if she's a specter, haunting me. As if I needed haunting. As if I needed reminding of everything anorexia has taken from the people I love and care about.

I won't be going back to that class.

Comments have been disabled on this blog post only.

Why Dick Cavett needs a muzzle. Or maybe a gag.

I used to like Dick Cavett. Of all the talk show hosts, he was the one known for his erudition, his intellectual streak. Johnny was the funny one, but Dick was the insightful interviewer, the one who came up with the best questions, whose show made you think.

I haven't been a fan of Dick's in a while, ever since he wrote this truly obnoxious blog post on obesity. Cavett's not the only painfully thin celebrity to weigh in (ha ha) on the subject, and he won't be the last. But his blog post seemed especially egregious to me, maybe because he wasn't responding to a current event, or an interviewer's question. He was just flying his fatphobic flag, loud and proud. By using words "heavily larded," "a herd of heifers," "the size of the Hindenburg," and other choice descriptors, Cavett showed off not only his vocabulary but his jejune perspective. (No, Dick, you're not the only one who knows fancy words.)

I thought I was over Dick Cavett. I really did. It's hard to stay pissed off at a washed-up ex-talk-show-host who's got nothing better to do than vilify people based on their appearance. Then he ticked me off all over again with a quote in this week's New Yorker magazine, in a piece by Ben McGrath on an odd little throwback of a recruitment video recently released by Yale.

McGrath quotes various Yale alums on the pros and cons of the video. Their comments are informative and amusing. That is, until we get to Cavett, who says, "“I wonder if it really was made in America, because there are no fatties.”

Really, Dick? That's your reaction? That the video features "no fatties"? What does that have to do with the subject at hand?

It seems that Cavett just can't put a lid on it; he's got to inject a little fatphobia into every conversation in print. Mercifully, there aren't too many of those, because, after all, he hasn't actually done anything worth mentioning in about 25 years. Maybe he's trying to line himself up a reality show. Maybe he wants to replace Howard Stern. Or maybe he's so obsessed with the subject of fat people that he literally can't help himself.

In which case, Dick, let me give you a few words of advice: Shut up already. You may have a high IQ, but your comments illustrate your ignorance, your prejudice, and your inherent lack of decency and kindness.

Come to think of it, maybe Rush Limbaugh has a co-host spot. Dick Cavett would be perfect for the job.

Ditching the concept of "refusal"

The editors of the venerable Diagnostic and Statistical Manual of Mental Disorders, otherwise known as DSM, have just released proposed revisions for the fifth edition of the book, due out in 2013. And WOO-HOO! They've taken out the word refusal in their criteria for anorexia nervosa.

That word has always bugged the crap out of me. It embodies everything I've come to dislike and distrust about conventional eating disorders treatment. It assumes that the person with anorexia is making a choice--a conscious choice--to not eat. It reinforces Hilde Bruch's characterization of anorexia and the people who suffer from it and the whole psychodynamic theory of AN--a theory that has absolutely no basis in scientific evidence or fact. A theory that has kept ED treatment in the 18th century, in my opinion, and condemned sufferers to years of ineffective treatment and torment.

So three cheers to the editors. I hope their proposed revisions make the final cut.

NEDA Walk in San Diego

You don't have to be in San Diego to support the first annual San Diego NEDA walk, which will be held on February 21. The walk is being hosted by the University of California San Diego's Eating Disorders Program--the same folks who run a five-day intensive outpatient program for families getting started with family-based treatment for anorexia or bulimia.

Sign up online to sponsor one or more walkers on UCSD's team, which includes Walter Kaye, Roxanne Rockwell, and Bridget Whitlow. Go, team!

A word about civility

Hey folks--

It should be clear by now that I'm not going to post comments that are rude, spiteful, mean, or abusive. I make an effort to be positive and constructive in my posts and when I respond to comments. I hold you to the same standards, or I won't be allowing your comments.

We don't have to agree. We do have to have a civil dialogue.

Frankly, my college writing students are far better at the whole constructive criticism thing than some of my anonymous commenters.

And you know what? It's hurtful. And hurt just breeds hurt.

So please, do yourself a favor, and either grow up or go comment on someone else's blog.

The Woman at the Y, Part 3

She was there again, the woman who comes to the Y sometimes. The woman who is so painfully thin I can see the shape of her femurs through several layers of clothes. The woman whose gaze is inward, whose face has the haunted look I recognize.

This time I tried to engage her before class--to reach out. I said hello. She looked at me and turned away. I haven't seen her talk to anyone, so maybe this wasn't surprising.

Usually she stays at the back of the class, but not today. Today she took a spot front and center, right behind the instructor and in front of the mirror. The harder the workout got, the more broadly she smiled at herself in the mirror. The more she smiled, the more sick I felt.

In the end I had to leave. I grabbed my coat in the middle of a song and ran out of the room, into a bathroom, where I cried and cried. I can't celebrate the joy of moving to music I love when I'm looking at her and imagining how many calories she's burning, how little she eats. When I know that she looks in the mirror and sees something completely different from what I see.

I don't know what to do, truly.

NAAFA takes on Michelle Obama's crusade against childhood obesity

I wouldn't normally repost a press release. But this one from the National Association to Advance Fat Acceptance is so well-researched and concisely effective that I can't resist.

Repeat after me, everyone: Shame is not a health-care strategy.

Enjoy.

NAAFA Challenges the First Lady

For Immediate Release
January 29, 2010

Oakland, CA – First Lady Michele Obama has recently announced her intention to focus on childhood obesity prevention. NAAFA encourages the First Lady to consider all the research before taking action and supporting any program that may do more harm than good.

Mrs. Obama, please explore and consider the following:

• When important figures such as parents, teachers and peers in children's social environment endorse a preference for thinness and place an importance on weight control, this can contribute to body dissatisfaction, dieting, low self-esteem and weight bias among children and adolescents (Davison & Birch, 2001; Davison & Birch, 2004; Dohnt & Tiggemann, 2006; Smolak, Levine, & Schermer, 1999).

• The stigmatization of large children has increased by 40% over the last 30 years (Latner & Stunkard, 2003).

• Many drugs presently being prescribed to children cause weight gain. There was a 40 fold increase in bi-polar diagnoses in children between 1994 and 2003. 90.6% of youth received a psychotropic medication during bipolar disorder visits. For many, mood stabilizers, antipsychotics, and antidepressants were also prescribed. (Arch Gen Psychiatr,. 2007)

• Prescribing dieting is, in effect, prescribing weight cycling, and many people will be fatter in the long run (Mann, 2007).

• Weight-control practices among young people reliably predict greater weight gain, regardless of baseline weight, than that of adolescents who do not engage in such practices (Neumark-Sztainer et al., 2006).

• Based on results from a population-based, longitudinal study with 2,500 teens, Neumark-Sztainer and colleagues at the University of Minnesota (2006) concluded that to prevent obesity and eating disorders, the focus needs to be on health much more than weight. The more weight per se is talked about, the more likely teens are to adopt dangerous dieting behaviors.

• A 2006 study from UCLA suggests our media and cultural obsession with achieving a certain weight does little or no good and may actually undermine motivation to adopt exercise and other healthy lifestyle habits.

• The National Center for Health Statistics, part of the Centers for Disease Control and Prevention indicated in 2008 that childhood obesity has leveled off.

NAAFA urges the First Lady to:

• Partner with us and our many resources in the scientific and healthcare communities to examine this issue. Fat children are already the targets of merciless bullying. NAAFA urges Mrs. Obama not to support any programs that would create a pervasive bias against fat children.

• Consider Guidelines for Childhood Obesity Prevention Programs found at: http://www.aedweb.org/media/Guidelines.cfm Childhood School Plans at http://www.healthyweight.net/schools.htm and Guidelines for Children at http://www.healthyweight.net/children.htm

• Support the Health at Every Size (HAES) tenets which state that healthy habits are good for EVERYONE, no matter what their size. Eat healthy, nutritious foods and enjoy occasional treats. Pay attention to your natural hunger and satiety cues. Move your body in ways that feel good rather than exercise focused solely on weight loss.

"Obesity has a strong genetic component that is expressed in environments that foster sedentary activity and eating an energy dense diet", stated Joanne Ikeda, Nutritionist Emeritus, University of California Berkeley, "Therefore, we encourage First Lady Michelle Obama to promote environmental changes in school settings that support enjoyable physical activity and consumption of a wide variety of nutritious, appetizing foods."

This issue is about the critical need to create environments in which children and adolescents do not feel shame or guilt about their bodies but, rather, are motivated to enjoy healthful eating and active living habits regardless of their body size or shape.

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

On the web:
http://www.naafa.org

News flash: A little "extra" weight can be a good thing

Especially if you're over 70, say researchers at the Western Australian Center for Health and Aging.

A recent study shows that normal-weight and obese patients over 70 had slightly higher levels of mortality than those whose BMIs put them into the overweight category--BMIs of 25 to 29.

In an article in the Journal of the American Geriatrics Society, the researchers said, "These results lend further credence to claims that the body mass index [BMI] thresholds for overweight and obese are overly restrictive for older people."

Makes sense to me--that "extra weight" is what Ellyn Satter describes as "nutritional resources." Food is fuel, folks. Your body needs food not just to power itself but to fuel resilience, especially as we get older.

Now I want to see them study this same notion in 60-year-olds. I'm curious about what the results might show.

Chicago conference! April 26!

If you're in the Chicago vicinity (or even if you're not), please join Maudsley Parents for a day-long conference featuring some of the smartest and most articulate researchers in the field of eating disorders.

Our speakers include Dr. Walter Kaye, director of the University of California San Diego's Eating Disorders Program, and Dr. Daniel Le Grange, director of the University of Chicago's Eating Disorders Program. They're two of my all-time favorite experts, and they'll have some exciting new research results to share. We'll also have a panel of parents who will share their experiences using Family-Based Treatment (FBT) to help their children recover from eating disorders.

Register here before Feb. 28 and the fee is only $40. After March 1, the fee is $50.

I'll be there--I hope to see you!

The decade's worst photoshopping, and it's all done on women

The first decade of the 21st century was apparently the decade of Photoshop. Here, Newsweek magazine takes us through some of the decade's most egregious Photoshopping as applied to women's bodies.

We know this kind of overzealous retouching happens, of course, but seeing it drives home the point: When it comes to women's bodies, our culture is seriously fucked up.

Because really, who is the Photoshopping for? Do men really prefer women who look like praying mantises to women with, well, normal proportions? Or is it women who judge one another (and ourselves) so harshly that we demand an unattainable beauty ideal for ourselves, damn it?

Well, neither. You know who loves images like this? Advertisers. Media advertisers. They're the ones trafficking in fantasies. And what is an unattainable beauty idea if not a fantasy?

So how can we respond? We can boycott the offending advertisers. We can consciously look at slideshows like this, reminding ourselves that the images on the left are not any less beautiful than the ones on the right that have been retouched. Au contraire--in pretty much every case I find the unretouched image far more powerful and moving than the ridiculously overdone fantasy on the right.


**Thanks to Christen Brandt for finding the slideshow!

Let's hear it for Gabby Sidibe's designer

. . . who has the guts to articulate, in an interview with the Washington Post, the sad truth about the fashion business: It exists not to serve women but to use them. As Megan Carpentier over at Jezebel writes, "If a designer wants to design a pair of formal, satin shorts with pleats and pockets because for some godforsaken reason he thinks that's cool, then he's got to find a rail-thin model to wear it, or else his design is going to look as ugly and unflattering as it actually is. If he wants to design clothes for women to wear, then he might actually be forced to take into account the women who will be wearing them."

And thanks to Carpentier for pointing out some of the cognitive dissonance in the story. Which is unsurprising. We as a society are so screwed up on the subjects of weight and health, it's a wonder we don't all burst into tears every time we walk into a clothing store.

OT: RIP Kate McGarrigle

Why I believe in fat activism

Scene: Meeting of my university's diversity committee (of which I am a member), where we have been planning a day-long diversity workshop for our faculty. Much conversation over who will be resistant to such a workshop, who is resistant to the idea of diversity in education in general. Much conversation in general over issues of cultural competence, etc.

The conversation turns to the current crisis in Haiti.

Professor Y: Some of the coverage on this has been unbelievably racist.

General agreement around the table.

Professor Z: Pat Robertson is talking about those "colored" people making a pact with the devil. And Rush Limbaugh, too. It's unbelievably offensive.

Professor X: Yeah, especially for a fat white guy like him!

Beat.

Me: Did you say "fat white guy"?

Professor X: (to his credit) I just caught myself.

Cut.

At the Y

She was there again this morning, in the vigorous Zumba class I take most Sunday mornings. I love this class because it's fun--exercising to blaring Latin music, following an instructor who shows rather than teaches the moves. I also love it because there's such a wide variety of ages and body types represented, from the hunched-over 70-something woman to 10-year-olds with their mothers. The women in the class--and we are women, although men are welcome--range from thin to fat. Each of us moves to the best of her ability. There are good dancers and bad dancers in the class, and it's all OK.

There are plenty of thin women in the class, but the woman who turned up this morning--second time I've seen her in class--is far thinner than anyone else. Her close-fitting black leggings reveal the shape of her femurs where they meet her jutting hipbones. Her arms look like they might snap at any moment. Her face has a look I've come to recognize, a driven look that also conveys flatness, a certain kind of despair.

You can't tell whether someone has an eating disorder from looking. But I'd bet a year's salary that this woman has anorexia.

Last time she turned up in the class, I went out to the front desk afterward and asked if the Y had a policy about people with eating disorders or whose health was compromised in other ways taking vigorous exercise classes. Shockingly, they do not. I explained my concerns to the woman at the desk, saying I was afraid this ill woman might collapse in class. Or worse. I hoped I wouldn't see her again.

But there she was this morning. In a sweltering room, she wore leggings and a sweatshirt zipped to her chin. I watched her exercise in the mirror; she didn't know most of the steps, being new to the class, but she threw herself into the dancing with determined force. She was burning calories. I couldn't tell if she was having fun. Most women in the class smile through much of it, but this woman's expression never changed.

I'd thought at lot about her since the last time I saw her in class, and decided I would try to talk to her after class, befriend her, get to know her. Only this time, like last time, she ducked out of class before the end. I glimpsed her on one of the elliptical machines on my way out, and wondered how many hours a day she spents at the Y.

I was struck recently by a quote in this film, made by documentary filmmaker Hope Hall about her mother, who's struggled with anorexia and bulimia for many years. The film includes a voiceover phone call between Hope and her mother, where her mother says, "Through all my growing up, through all my marriage, I was always trying to measure up, trying to be somebody else. And all of a sudden, you said, 'I just love you. I don't need you to be well.'"

I think about the woman at the Y, and am torn by what I wish for her. I hope she people in her life who just love her. But I also wish that she, and everyone with an eating disorder, had people in their lives who could help them get well. Who could help them out of the private hell of anorexia and bulimia and into a life filled with something besides starving and binging and suffering.

I hope the woman does not come back to class, because, selfishly, I am uncomfortable seeing her there. In her gaunt face I see the face of my daughter, Kitty, at her sickest. I imagine Kitty at age 40, living this kind of hell, and I feel sick.

I wish I knew what I could do to help.

A difficult childhood = health risks?

I know from my own experience that childhood traumas can turn into psychological issues in adulthood. Now new results from a long-term study in California suggest that certain kinds of childhood traumas can translate into other kinds of health risks.

As reported in Time magazine, researchers at Kaiser Permanente have found correlations between certain kinds of traumatic events in childhood--sexual, physical, and emotional abuse--and elevated risks of heart attack, stroke, depression, emphysema, and, yes, my favorite bugaboo, obesity.

Here's a quote from the Time story:

"For the past several decades, the ACE study has recorded reports of negative childhood experiences in more than 17,000 patients. Adverse experiences include ongoing child neglect, living with one or no biological parent, having a mentally ill, incarcerated or drug-addicted parent, witnessing domestic violence, and sexual, physical or emotional abuse. . . . Compared with a person with no adverse childhood experiences, or ACEs, a person with four or more has almost double the risk of obesity. Having four or more ACEs more than doubles the risk of heart attack and stroke, and nearly quadruples the risk of emphysema. The risk for depression is more than quadrupled. Although many of these outcomes could reflect the influences of genes and other environmental influences — beyond those occurring in childhood — the tight relationship between increasing ACE numbers and increasing health risks makes the role of child trauma clear."

Some of these correlations seem straightforward, like the one between ACEs and emphysema, which can be explained at least in part by higher levels of smoking-as-self-medication. But this study takes the correlation a step further:

"Early adverse experience can disrupt the body's metabolic systems," says Dr. Jack Shonkoff, director of Harvard's Center for the Developing Child. "One of the cornerstones of biology is that our body's systems when they are young are reading the environment and establishing patterns to be maximally adaptive." Researchers also posit that high levels of stress hormones caused by ACEs can wear down the body over time. A temporary spike in blood pressure in response to a stressful event may be useful to power an adaptive fight-or-flight response, but over the long term constant high blood pressure could raise a person's risk for heart attack and stroke. Studies have also found that consistently elevated levels of stress hormones, like cortisol, can lead to permanent damage in certain brain regions linked to depression.

Even more interesting, they suggest that such stress-induced physiological changes can be passed down through the generations through epigenetics, changes in the traits expressed by genes that don't come from mutations in DNA.

Fascinating stuff. What it suggests to me is yet another refutation of Cartesian dualism. What we think and feel and experience may shape us in more ways than we know.

What do you think?

Anorexia ≠ autism

Of late, several researchers have been exploring a possible link between anorexia nervosa and autism spectrum disorders. I've never understood why. It seems fairly clear to me that acute anorexia brings with it an altered state of consciousness that has little to do with a person's ordinary state of mind or ability to interact with people. In his seminal study on human starvation, researcher Ancel Keys noted that those in the throes of semi-starvation tend to lose both the interest in social interactions and the ability to pull them off. That certainly echoes my own observations.

Now, thankfully, researchers at King's College in London have come to the same conclusion. The study's authors write, "These findings indicate almost complete normalization of emotion recognition ability in recovered patients, despite the observation of difficulties in both domains in currently ill patients. Findings suggest that similarities between AN and ASD are restricted to the currently ill AN state and such difficulties in AN may be a factor of starvation."

Now, can we move on to more fruitful avenues of research, please? Like developing effective treatments?

"Plus-sized" models in a mag spread

While I question the plus-sized designation on some of these women (one is a size 10, which is plus-sized only in the insane world of fashion), I love these elegant spreads from an Australian magazine called Madison. A shout-out to Australian blogger Julie Parker for linking them on her blog, Beautiful You.

Follow-up: Lincoln University

According to the Associated Press, Lincoln University has dropped its requirement for fat students to take a special fitness class.

But, you know, they still don't get it. Because apparently, some freshmen will have the course "suggested" to them after they take a health class.

Dudes, when are you gonna cotton on? If the class is really all about health, and you think it's important, all students should take it.

And if it's all about weight loss? No students should take it.

A few thoughts on "refusal"

One of my gripes with the current thinking about eating disorders lies in the very definition of anorexia nervosa, as found in DSM-IV, the psychiatric bible:

Refusal to maintain body weight at or above a minimally normal weight for age and height.

It's the word refusal, frankly, that bugs the hell out of me, with its implication of volition. It suggests that people with anorexia nervosa could maintain their body weight, if they really really wanted to, which suggests, in turn, that AN is a disease of choice.

Nothing, in my experience, could be further from the truth.

So I was delighted to read, in the November issue of the International Journal of Eating Disorders, a literature review by Harvard Medical Schools' Dr. Anne Becker recommending that the word be changed in the next edition of the DSM. According to Becker, "The term 'refusal" in AN criterion A is potentially inaccurate, misleading, and pejorative." Woo-hoo! It doesn't get any more straightforward than that.

Becker, et. al., go on to write:

By implying agency and willfulness, the phrasing . . . may promote stigmatization of AN. In particular, the connotation of the word 'refusal' as behavior that is oppositional may perpetuate the notion that a patient is in control of her symptoms. Research has highlighted the stigmatization of AN both by the public, who appear likely to blame the patient for her illness and to believe she could "pull herself together" if she so desired, and by medical professionals.

Thank you, Dr. Becker, for setting the record straight. May the rest of the ED treatment community take your words to heart.

Lincoln University: Epic fail

Lincoln University, a historically black college in southern Pennsylvania, has made the news recently for jumping on the now-mandatory "wellness" bandwagon. As reported in the Chronicle of Higher Education, Lincoln's version is to institute a policy of weighing and measuring all freshmen; those with BMIs over 30 are required to take a one-credit course called "Fitness for Life" sometime before they graduate.

This policy exemplifies the worst of what's wrong with the way we as a culture approach fitness, health, and wellness. Like so many other institutions jumping on this bandwagon, Lincoln makes a fatal error in logic: It conflates weight with fitness.

So heavier freshmen at Lincoln are assumed to be "unfit" and "unhealthy." Just as bad, thinner freshmen are given a pass on the fitness course, the assumption being that they don't need it because they're not that fat.

If fitness and good health are the goals, shouldn't everyone have to take the course?

Some people object to the fitness course on libertarian grounds. Not me. I think good health and fitness is part of what we should be teaching children and practicing ourselves. But threatening or punishing larger people because of their size is not a useful strategy. As a researcher from the National Institutes of Health said recently, the number-one cause of obesity in this country is dieting. Programs like this buy in to the fat-is-unhealthy mindset. They also buy in to the thin-is-healthy mindset. By conflating weight with disease they do everyone a grave disservice.

My own school, Syracuse University, is looking at "wellness" programs right now. I hope I don't have to write a piece like this about SU someday.

PSA: Why you should always hire a trained journalist

Because if you don't, your newscasts will look like this.

BODYTALK: The video

Sara Sultanik, a talented grad student here at Newhouse, put together this cool video about the BODYTALK project. Thanks, Sara!

Everyone else--what are you waiting for? I'd love to get an MP3 from you for the BODYTALK project.

Newsflash: HAES Really Works!

At least, according to researchers at Laval University in Quebec, who have just published the results of a randomized trial comparing Health at Every Size with other food-related interventions.

The study involved premenopausal women considered overweight or obese, who spent time either in an HAES group, a support group, or a control group. A year after the trial had ended, the women in the HAES group had less "situational susceptibility to disinhibition," meaning they were less likely than women in the other two groups to overeat when triggered by stress, abundance, and other external situations. Women in both the HAES and support groups ate less in response to perceptions of hunger.

I'm a little irked that the ScienceDaily writeup of the study refers to HAES as a "new weight paradigm." But hey, it's still good news, and the beginning, I hope, of more studies looking at the benefits of HAES. Now, if only I could get these study results to the last group of doctors I spoke to . . .

Project BODYTALK: Anyone can record a commentary

I was interviewed this morning for the SU campus newspaper about Project BODYTALK. The reporter asked me an interesting question: Do I think that the act of telling your story around food and body image is healing? Is that what I hope to accomplish through this project--healing for the people who tell their stories?

My answer: Absolutely. But I also know that healing--in whatever form--will also happen through listening to these powerful stories.

To that end, I'd like to collect as many commentaries as possible. You don't have to have an eating disorder or serious body image issue to tell your story--in fact, I'd like to hear from people who feel good about their bodies, too!

Project BODYTALK starts today on the Syracuse University campus--but you don't have to come to campus to participate. Record your commentary in the privacy of your own living room and send it to me as an MP3 file. Please say your name and age at the start of the recording; if you want to remain anonymous, say that on the file too, and I'll edit it out.

If you want to submit a file, send it to hnbrown at syr dot edu.

If you're in or near Syracuse, come on down to the BODYTALK audiobooth any day this week or next between 3 and 8 p.m.: Newhouse 2, Room 472, studio P.

I hope to hear your story.

The BODYTALK project

If you live in central New York, please come participate in the BODYTALK project at Syracuse University. It's modeled after NPR's Storycorps booth, a traveling audio booth where people could record anonymous commentaries about things that mattered to them.

BODYTALK gives people a chance to record commentaries about their relationships with their bodies, appearances, food, eating, and weight. For the first two weeks of November, a recording studio at SU's Newhouse School of Public Communications (where I teach) will be set aside for anyone who wants to record a commentary. You can give your name or do it anonymously. Some commentaries will air on NPR's national show 51%; others will, I hope, be published eventually on a website.

If you can't get to Syracuse, you can record your own commentary and send me the mp3 file. I'd love to have as many people as possible take part in the project.

Who: Anyone!
What: Record a commentary (between 3 and 10 minutes long) in
Newhouse 2, Room 472, Suite P
When: Nov. 2-13; most days 3-8 p.m. (sign up at suite P, or walk
in at any time)

Because the more we talk about these feelings, the more shame and stigma will fall away.


*Photo originally published by Roosevelt University.

Help a grad student

Tina Indalecio, who's getting her PhD at Fielding Graduate University, is running a survey on how advertising media affects people with eating disorder or body image issues. I'm all for anything that helps with research around eating disorders, because God knows there's not very much of it.

So if you'd like to help Tina, you can read more about her research and/or take her survey here. The password you'll need is temp1212. The deadline for participating is Wednesday, October 28, by 11:45p.m.

You can also check out Tina's blog here, and her documentary project here.

Watch and learn

Even I'm surprised by some of what I saw in another of the Dove Campaign for Real Beauty videos. . . .




**Thanks, Erik, for sending it my way.

Interview with Dr. Katharine Loeb

Here's the latest in a series of video interviews with some of the top researchers in the field of eating disorders, done by Jane Cawley, co-chair of Maudsley Parents. This interview with Dr. Katharine Loeb of the Mt. Sinai School of Medicine offers sound, practical advice for parents of teens with anorexia.

Anorexia Nervosa in Teens: What Parents Should Know from Jane Cawley on Vimeo.

Take a look. Let me know what you think.

In honor of the High Holidays. . . .

Long before anorexia came to our house, I refused to fast on Yom Kippur. I understand the idea behind a 24-hour fast: to "cleanse" the mind of its emphasis on the corporeal, and to refocus it for a time on the spiritual.

For me, though, a fast made me think more about my body and its needs, not less. Standing in synagogue, beating my breast, all I could think about was food and hunger.

At 13, the first year I was "allowed" to fast, I became so ill with hunger that sometime during that long afternoon, I ate part of a candy bar I found buried in the sandbox behind our synagogue, and spent the rest of the night throwing up.

Personally, I'm much more able to feel spiritual when I'm well fed, well rested, and centered.

Jews wish one another an easy fast in honor of Yom Kippur. Since I don't fast--and since I hope those of you who are actively dealing with an eating disorder are not fasting either--I will wish you instead a day of contemplation, of connection to yourself and others, and a refocusing on your true appetites, whether they are spiritual, physical, emotional, or creative. Whatever your concept of holiness, I hope you can find some corner of it today.

To help you along, here's a gorgeous recording of Jacqueline du Pre playing Kol Nidre, courtesy of my friend Kay.

Scared straight?

These kind of scare tactics are, after all, the logical extension of the "war on obesity."

Only the author of this little news item is forgetting something rather important: food and cigarettes don't play the same role in a human being's life. You can live (much better, thank you) without smoking. You can't live without eating.

So what, exactly, is this fear-mongering supposed to accomplish? How about a new generation of disordered eaters? Oh, right, we've already got that. So . . . what's left? A new diagnosis for DSM-V--cibuphobia?*

*Cibus = latin for "food"

For all the perfectionists out there . . .

I believe this with all my heart.

If you never fail, you aren't living.




**Thanks, Shander!

New research study

If you struggle with binge eating disorder and live in the Boston area, this study might be of interest. You've got to be between 18 and 50 years old and a non-smoker, at least for the last six months. For more details, see the study posting.

I'm a fan of taking part in research studies-IF they offer you something useful.

For information contact Miguel Alonso-Alonso, malonso@bidmc.harvard.edu.

Just when you think you've seen it all . . .

comes this appalling cookbook, Hungry Girl, which touts itself as offering 200 recipes under 200 calories each.

The title says it all, to my mind: Hungry girl. Is that what we're aiming for here? To make sure girls stay hungry? Not to mention malnourished, obsessed, and generally distracted from more important matters?

Just think of all that women could achieve--women, not girls--if they weren't hungry all the time, or thinking about food, or worrying about what they're eating or not eating.

Imagine.




**Thanks to Katie Dummond.

"You've lost weight!"

That's what a colleague said to me yesterday, a woman I haven't seen for six months. A woman who is tall and broad and neither thin nor fat.

I haven't lost weight; if anything, I've probably gained a pound or two. Which is irrelevant, really, because I've had people say this to me whether I've lost or gained or stayed exactly the same.

And it's a comment I never know how to respond to, because there are so many assumptions wrapped up with those three little words: The assumption that I'm trying to lose weight, or at least wishing to. The assumption that losing weight will make me look better. That assumption that losing weight, or trying to, is a positive thing. The assumption that it's OK for someone I don't know well to comment on my appearance.

I've considered a variety of responses to this comment, everything from "Please don't comment on my appearance" to "Thanks." What I said yesterday was a simple, "Actually, I haven't."

My colleague persisted. "No, you really have," she said. "You look--" She gestured toward my body. "Maybe it's the shirt," she said.

"Maybe," I said. I walked away feeling ungracious. Should I have said thank you? In our culture, telling a woman she's lost weight--especially a woman who is not thin--is a compliment and a social offering. I like this colleague a lot; I know she meant well. Yet I'm very uncomfortable at this point with comments like this. They are also teachable moments. But, you know, sometimes I get really tired of teaching.

I'm not sure I said the right thing. I'm not sure what the right thing is. Any thoughts?

Have you ever been on the receiving end of weight-based discrimination?

If so, I'd like to hear from you. I'm doing a story for the NY Times science section on this and would like an anecdote or two, especially having to do with work, jobs, etc.

Email me at harriet at harrietbrown dot com.

What the World Eats

Today I stumbled onto this fascinating excerpt from a book called Hungry Planet, which was serialized on the Time magazine website when it came out a few years ago. Photographer Peter Menzel and writer Faith D'Alusio visited 30 families in 24 countries to research this collection of portraits. Each family is shown with a week's worth of food, along with the cost of that food (in local money and in U.S. dollars), plus a list of the family's favorite foods and/or recipes.

The photos are eye-opening, literally, especially when you compare, say, the abundance and variety of foods eaten by a family of four in Germany (cost: about $500 a week) with the much more meager and monotonous foods eaten by a family of five in Chad (cost: $1.23). The lists of favorite foods include everything from rice to polar bear to pastries.

There's something quite wonderful about the way these photos show us, without posturing or judgment or politics, each family's relationship with food. I was especially captivated by this as I've been contemplating a similar personal photo project. But this is so much better.

Is Your Child One of the 12 Percent?

One of the things you hear a lot these days--at least if you spend any time talking to doctors about eating disorders--is that they affect a relatively small number of kids. Prevalence rates for anorexia are usually quoted as .5 to 1 percent, and 3 to 6 percent for bulimia. (Binge eating disorder is a newer diagnosis; I've heard 3 percent for BED but don't know if it's accurate.) Which somehow makes them less worthy of attention, concern, and research money than, say, childhood obesity, which as we all know is public healthy enemy #1. (That's sarcasm, y'all.)

But a new study out of University of Texas at Austin shows that fully 12 percent of all adolescents experience some form of eating disorder. That's 12 out of 100. Which may not sound like much.

But consider that 1 out of 15,000 kids gets cancer of some kind, and think about the attention and research and money devoted to understanding and treating childhood cancers. Then think again about the number: 12 percent.

It sounds a lot bigger now.

One of the pervasive problems in treating eating disorders is a lack of effective treatments. We need more research, which needs we need more research dollars. One reason we don't get those dollars is that families are often reluctant to acknowledge that their child has an eating disorder because of the stigma associated with these illnesses.

Cancer used to carry a lot of stigma, too. As a culture we've mostly gotten over that. How about we start challenging the stereotypes around eating disorders? Parents could be amazing advocates, if only we were willing to stand up and say, "Yes, my child is one of the 12 percent--now what are we going to do about it?"

How about it?

See you in . . . October?

For those of you in the D.C. area, I hope you'll join me and some very special guests at a conference on eating disorders, hosted by Maudsley Parents. This half-day get-together features two of the leading researchers in the field of eating disorders, both of whom are accessible, compelling speakers. Daniel le Grange heads up the University of Chicago's Eating Disorders Program; Walter Kaye directs the University of CalIfornia-San Diego's program.

Dr. le Grange will discuss family-based treatment (the Maudsley approach) for both anorexia and bulimia. Dr. Kaye will give us insights into the neurobiology of eating disorders. And I'll share my family's story and offer parents specific strategies and tips for helping a child through an eating disorder.

You can find more information and sign up for the conference here. (If you sign up before September 14, the cost is only $25 per person.) I hope to see you there!

Et tu, New York Times?

Funny--I just spent an hour on the radio talking about the stigma of being fat, and lo and behold, this incredibly mean-spirited snarky piece appears in the New York Times.

I'm happy to see that Jezebel called the Times out for this offensive story, which includes paragraphs like this one:

The petites section features a bounty of items for women nearly as wide as they are tall; the men’s Big & Tall section has shirts that could house two or three Shaquilles. And this is really, remarkably smart.

The writer, Cintra Wilson, seems unfamiliar with the concept that fat people wear clothes and spend money too.

I think this is a job for the Times' public editor, don't you? You can email Clark Hoyt at public@nytimes.com.

Fat acceptance on Radio Times

I just finished doing a call-in show on Radio Times, a public radio show on WHYY, on fat acceptance and on our relationship to food and eating and weight. It was a good show, and included some excellent comments from Rebecca Puhl of the Rudd Center for Food Policy and Obesity at Yale.

You should be able to listen to an archived version of the show here eventually.

I thought it was interesting, and somewhat sad, that pretty much all the callers espoused the "thin-is-healthy" and "thin-at-any-cost" idea. For those of you who may be finding this blog after hearing the show, I'd love to direct you to a couple of good resources.

I hope you'll check out Ellyn Satter's wonderful website and books. Satter, a nutritionist, therapist, and researcher, advocates for what she calls competent eating--meaning, eating in a way that satisfies your hunger and your appetite. She writes about the need to develop a joyful relationship with food and eating--a radical concept in our current culture, and one worth considering.

One of the callers mentioned anger and snarkiness among the Fat Acceptance blogs. I don't know how you define snarkiness, exactly, but I quite like some of the FA blogs, including Shapely Prose, The F-Word, and The Fat Nutritionist.

Finally, in my recent book, Feed Me: Writers Dish About Food, Eating, Weight, and Body Image, I published a Love-Your-Body pledge, which is also available here. I hope you'll consider signing it. Paste it up where you'll see it everyday, and remind yourself about what you love and appreciate about your body.

Bob Herbert: What he said

Read it here.

Thanks, Bob.

Obesity & eating disorders: the link

Researchers at the University of Minnesota (where, 60 years ago, Ancel Keys did his pioneering work on starvation) are beginning to quantify the links between overweight and eating disorders in kids. Their newest study looks at the risk factors that make overweight teens vulnerable to behaviors that are part of eating disorders: self-induced vomiting, using diet pills and laxatives, and binge eating. They also look at socio-cultural factors that contribute--reading a lot of magazines articles about dieting, for instance.

The research is led by Dianne Neumark-Sztainer, who's done some excellent work on weight over the years. It's worth checking out, especially in light of our current hysteria around obesity and the plethora of intervention efforts aimed at kids, which I fear are creating a tidal wave of eating disorders. (They certainly don't make kids thinner.)




Thanks to Jane for pointing out this research!

Save the date: October 5

Please join Maudsley Parents for a half-day afternoon conference on family-based eating disorders featuring two of the research world's heaviest hitters (and best speakers): Dr. Walter Kaye, of UC-San Diego, and Dr. Daniel LeGrange of University of Chicago, co-author of Help Your Teenager Beat an Eating Disorder. Yours truly will also speak.

The conference will be held at the Bethesda Marriott in Bethesda, Maryland. More details to come--stay tuned!

Sneak peek: Prologue

Hello all,

I appreciate very much the community that has developed around this blog (and others) over the last few years. Which is why I'm asking if you will do me a favor and read the prologue of the book I'm working on, tentatively called THE DEMON IN THE BAKERY. It's a family memoir about my daughter Kitty's anorexia and recovery.

Warning: This prologue may be triggering for those who are actively eating-disordered or in recovery, so please, skip it.

The rest of you--I'd value your honest reactions and feedback.

Thanks.



PROLOGUE: THE DEMON IN THE BAKERY

Close your eyes. Imagine that you’re standing in a bakery. Not just any bakery—the best bakery in Paris, its windows fogged, crowded with people who jostle for space in front of its long glass cases. The room is fragrant and you can’t take your eyes off the rows of cinnamon rolls and croissants, iced petits fours, flaky napoleons and elephant ears. Every counter holds at least one basket of crusty baguettes, still warm from the oven.
And you’re hungry. In fact, you’re starving. Hunger is a tornado whirling in your chest, a bottomless vortex at your core. Hunger is a tiger sharpening its claws on your tender insides. You stand in front of the glass cases, trying to swallow, but your throat is dry and your stomach clenches and contracts.
You want more than anything to lick the side of an éclair, swirl the custard and chocolate against your tongue. You dream about biting off the end of a cruller, feeling the give of the spongy dough, the brief molecular friction of the glaze against your teeth, flooding your mouth with sweetness. The woman beside you reaches into a white paper bag, pulls out a hunk of sourdough roll. You see the little puff of steam that flares from its soft center. She pops it into her mouth and chews and you chew along with her. You can almost taste the bread she’s eating. Almost.
But you can’t, not really, because how long has it been since you’ve tasted bread? A month? A year? An eternity. And though your stomach grinds against your backbone and your cheeks are hollow, though the tiger flays your belly, you can’t eat. You want to, you have to, but your fear is greater than your hunger. Because when you do—when you choke down a spoonful of plain yogurt, five pretzel sticks, a grape—that’s when the voice in your head starts up, a whisper, a cajoling sigh: You don’t need to eat, you’re strong, so strong. That’s right. Good girl.
Soon the whisper is a hiss filling the center of your head: You don’t deserve to eat. You’re weak, unworthy. You are disgusting. You don’t deserve to live. You, you, you. The voice is a drumbeat, a howl, a knife sunk in your gut, twisting. It knows what you’re thinking. It knows everything you do. It has always been inside you and it always will be. The more you try to block it out, the louder it becomes, until it’s screaming in your ear: You’re fat. You’re a fat pig. You make everyone sick. No one loves you and no one ever will. You don’t deserve to be loved. You’ve sinned and now you must be punished.
So you don’t eat, though food is all you think about. Though all day long, wherever you are—doing homework, sitting with friends, trying to sleep—part of you is standing in the bakery, mesmerized with hunger and with fear, the voice growling and rumbling. You have to stand there, your insides in shreds, empty of everything but your own longing. There will be no bread for you, no warm, buttery pastries. There’s only the pitiless voice inside your head, high-pitched, insistent, insidious. There’s only you, more alone than you’ve ever been. You, growing smaller and frailer. You, with nowhere else to go.
The voice is part of you now, your friend and your tormentor. You can’t fight it and you don’t want to. You’re not so strong, after all. You can’t take it and you can’t get away. You don’t deserve to live. You want to die.
This is what it feels like to have anorexia.

* * *

I’ve never had anorexia, but I’ve lived with it. I’ve observed it closely in someone I love: my oldest daughter, Kitty, who was 14 when she got sick. I watched as the happy, affectionate girl I knew became furious and irrational, obsessed with food but unable to eat. I saw her writhe in terror, heard her beg my husband and me for help and then, in the same breath, shriek that we were trying to poison her, to make her fat, to kill her. I heard a voice I did not recognize come out of her mouth, saw her gaunt face changed beyond knowing. I held her in my arms and felt the arc of every rib, counted the bones in her elbows, saw her breastbone press out through the paper-thin skin of her chest. I felt her body shake and knew that whatever comfort I offered it wasn’t enough, it was nothing in the face of the thing that was stripping the flesh from her bones and the light from her eyes.
I had no idea anorexia was like that.
Before Kitty got sick, I thought eating disorders happened to other people’s children. Not to my daughter, who was savvy and wise, strong and funny, the kind of kid who picked her way through the pitfalls of toxic middle-school friendships. She did fit the profile: she was a perfectionist, fastidious about how she looked and dressed. She was hard on people sometimes, especially herself. She was athletic, a gymnast, traveling around the Midwest for meets; her favorite event was the balance beam—fitting, I thought, for a child who so gracefully walked the line between childhood and adolescence.
But she would never have an eating disorder. She was way too smart for that.
Before my daughter got sick, I thought kids with anorexia or bulimia wanted attention, that they were screwed up and tuned out, bored or acting up or self-destructive. But my daughter was none of those things. She seemed cheerful and well adjusted; she had friends, interests, a passion for new experiences. She wrote her sixth-grade research paper on eating disorders. She knew the dangers. She would never choose to have anorexia. She was safe.
I was wrong about many things, but I was right about that one thing: Kitty didn’t choose anorexia. Anorexia chose her. And it nearly killed her.
At Kitty’s lowest weight, her heart beat dangerously slowly; it could have stopped at any time. Between 10 and 20 percent of people with anorexia die from heart attacks, other complications, and suicide; the disease has the highest mortality rate of any mental illness. Or Kitty could have lost her life in a different way, lost it to the rollercoaster of relapse and recovery, inpatient and outpatient that eats up, on average, five to seven years. Or a lifetime: only half of all anorexics recover in the end. The other half endure lives of dysfunction and despair. Friends and families give up on them. Doctors dread treating them. They’re left to stand in the bakery with the voice ringing in their ears, alone in every way that matters.
Kitty didn’t choose anorexia because no one chooses anorexia, or bulimia, or any other eating disorder. Intelligence is no protection; many of the young women (and, increasingly, men) who develop anorexia are bright and curious and tuned in. Families are no protection, either, because anorexia strikes children from happy families and difficult ones, repressed families and families who talk ad nauseam about feelings. The families of anorexics do share certain traits, though: A history of eating disorders, or anxiety, or obsessive-compulsive disorder. Or all of the above.
I’ve never had anorexia, but I know it well. I see it on the street, in the gaunt and sunken face, the bony chest, the spindly upper arms of an emaciated woman. I’ve come to recognize the flat look of despair, the hopelessness that follows, inevitably, from years of starvation. I think: That could have been my daughter. It wasn’t. It’s not. If I have anything to say about it, it won’t be.
This is the story of our family’s struggle. Kitty was diagnosed with anorexia in June 2005. In August of that year we began family-based treatment (FBT), also known as the Maudsley approach, to help her recover. That was the start of the hardest year of our lives and, especially, Kitty’s. That year, I learned just how brave my daughter is. Five or six times a day, she sat at the table and faced down panic and guilt, terror and delusions and physical pain, and kept going. And she emerged on the other side. After months of being lost, she came back to us and to herself, and the world took on color and sound and meaning once more.
So this book is for Kitty, and for all the children and teenagers and adults who have struggled or continue to struggle with an eating disorder: for your courage, your strength, your capacity to not just endure but overcome. I honor you with every word.

10 reasons why BMI is bogus

I love, love, love this piece from NPR on the top 10 (suggesting there are more than 10) reasons why BMI is a bogus measurement. My favorite:

The person who dreamed up the BMI said explicitly that it could not and should not be used to indicate the level of fatness in an individual.

Go read the rest for yourself.

Hey kids!

Want to develop a lifelong obsession with eating? How about an eating disorder? Or at the very least years of self-loathing toward your body? Have we got an idea for you! Start writing down everything you eat. That's right--every single bite you eat goes into this handy-dandy food journal that the folks at the Washington Post think you should keep.

Start now! Before you know it, you'll be on your way to a lifetime of unhappiness!

Grrrrr.

Listen in . . .

. . . to a fabulous radio show hosted by Susan Barnett of 51%, on body image, dieting, and anorexia. Barnett held a roundtable with four contributors from Feed Me, and then graciously gave me some airtime for a commentary as well. Good stuff.

Offline

I can't tell you how much I appreciate everyone who reads and comments on this blog. It means a lot to me to have the kind of thoughtful, intelligent discussions we do here with all of you.

For the next month or so, though, I'll be offline at a writing retreat. I hope to emerge refreshed and mostly through done writing my next book, BRAVE GIRL EATING.

Happy June!

Has your family been denied insurance coverage for an eating disorder?

I got a call this morning from a staffer at Good Morning America, looking for families to profile and potentially help with insurance coverage. If you're interested please get in touch ASAP.

Interview on True/Slant

Katie Drummond is an interesting young Canadian writer living in NYC and writing for a site called True/Slant. She interviewed me last week for the site, and here's a link to the results of that chat. It's always good to see eating disorders covered intelligently rather than in the Madonna/whore way of most media outlets, where people are either "accused" of having anorexia or ridiculed for being fat because they're wearing size 2 jeans.

Knitting and EDs

I have to admit my eyebrows went up when I first read about this study, which looked at whether the act of knitting could help people recovering from eating disorders. There are a lot of wacky, unproven, and frankly ridiculous "therapies" out there for eating disorders, many of which are rubbish.

But this one actually makes sense. Researchers from the University of British Columbia, Oxford University, and the Beau Cote Centre for Eating Disorders looked at whether the repetitive act of knitting could help with the inevitable anxiety and perseveration that comes along with the recovery process. While their study sample was small--38 women on an ED ward in a hospital--the results suggest that knitting did in fact have something of a calming and even therapeutic effect.

I can understand the principle: For me, washing dishes or weeding provides a similar effect. Human beings are hard-wired to work with our hands. And repetitive work like knitting can facilitate a zenlike meditation state that can be very soothing.

I like the fact that the researchers aren't claiming that knitting helps people recover from EDs. They point out instead the secondary but still important component of anxiety management. And I know not only from my own experience but also from Ancel Keys' Minnesota Starvation Study that anxiety is a major biological component of re-feeding and recovery.

And if knitting helps with anxiety, I'm sure there are other activities that do the same, that help break the cycle of obsessive thinking that comes along with EDs. Maybe crocheting? Quilting? Fiber arts as ED recovery corollaries? I love it.