Project BodyTalk goes live!

After nearly a year of development and work, I'm pleased to announce that thanks to my fabulous graduate assistant, Megan Swann, we've got a website up and running for Project BodyTalk. I've been writing about eating disorders for a while now, and at some point I began thinking that it would be really fabulous to be able to hear the actual voices of people who struggle with EDs. I'm also a radio devotee and big fan of shows like This American Life and the StoryCorps project.

From these sources, Project BodyTalk was born. It's an audio project that collects commentaries on the subjects of food, eating, body image, and eating disorders. Here on the Syracuse University campus, we opened a recording booth for a couple weeks last fall and collected a number of commentaries from students, faculty, and community members who came up to campus to record. Since then I've had people send me mp4 and mp3 files. A couple of teachers at a high school in Baldwinsville had students record commentaries.

The first commentators were told to record a commentary anywhere from 1 to 10 minutes, on any related subject. Some people told stories about friends and family members struggling with body-related issues. Some talked about foods they love. Some talked about what it's like to be fat, or thin, to have anorexia or binge eating disorder, to feel pressured to look a certain way. It's turning into a wonderfully eclectic, diverse, and moving project.

So . . . the website is up and running with the first half dozen commentaries. Over the next few months I'll be editing and uploading more commentaries, and, I hope, collecting them too.

We've also got a page labeled ACT, where I'm posting links and descriptions of other body-positive projects. If you've got one to share, send me info, and I'll happily add yours to the page.

I'd love your feedback--and your commentaries.

*Image by Megan Swann.

Bring Brave Girl to your town!

I've started planning a book tour in earnest for BRAVE GIRL EATING, my memoir about our family's struggle to help our daughter recover from anorexia. My goal: To visit as many towns, especially university towns, as possible, and to get in front of as many pediatricians, doctors, therapists, and families as I can.

Here's where you come in, dear readers: I need your help arranging events in your town. I'm aiming to get on the schedule for university lecture and talk series, because I know this book will be of interest to both the scientific community (it's got lots of science and neurobiology for all you geeks, and I count myself among you) and to college audiences. The best way for me to make contact with folks around the country is through someone who's already in the community and who can broker an introduction and help me connect with the right person.

I'd love to come speak in your town, at your university, in your state--hell, in your doctor's office. So if you can help please let me know. My email addy is harriet at harrietbrown dot com. Tentative schedule to come in the next few weeks, I hope!

Are you a size-accepting fat woman?

If so, please consider helping grad student Micheala Null, a doctoral student in sociology at Purdue University, by taking a brief study and potentially doing an interview. Details are below.



*********************

Call for Participants

Hi, my name is Michaela A. Null, and I am a doctoral student in Sociology at Purdue University. I am doing a study about the embodiment of size-accepting fat women, with attention to the ways in which gender, race, sexual orientation, and
body size intersect.

I am currently looking for individuals who are interested in volunteering to participate in my study. If you are interested in volunteering to participate in an interview, I ask that take an electronic informational survey, which will take approximately 5 minutes. Please go here and complete the informational survey. After all survey data has been collected, participants will be selected for interviews, which will be conducted in-person, by phone, or via internet chat, and will last between an hour and an hour and a half.

Participation is voluntary and participants must be at least 18 years old.

This project has been approved by my university’s Institutional Review Board, which protects human subjects of research. I will provide confidentiality to all volunteers and participants will be referred to by a pseudonym in all research documents.

If you have any questions regarding this study, you can contact me at mnull@purdue.edu. For more information on me, you can access my university profile here.
You can also contact Professor Eugene Jackson, Assistant Professor of Sociology at Purdue University, at jacksone@purdue.edu.


Sincerely,

Michaela A. Null
Doctoral Candidate
Instructor for Women's Studies
Purdue University
Department of Sociology
700 W. State Street
West Lafayette, Indiana 47907-2059

Check the Huffington Post . . .

for my response to the White House Task Force on Childhood Obesity.

Add your comments, please. I'm sure there will be plenty of the wrong kind up shortly.

Kudos to the eating disorders work group on DSM-V

for deciding not to make obesity a disease in the next edition of the Diagnostic and Statistical Manual of Mental Disorders.

This decision has significant ramifications for how docs treat and to some extent see obese patients. I'm a big proponent of changing the dialogue around obesity from a discussion of weight to a discussion of health. The two are not synonymous. I'm also hoping this will stop bariatric surgeons from marketing their surgeries as eating-disorder treatments, for instance.

The group also recommended changing criteria for anorexia and bulimia:
• Now patients must weight 85% of ideal body weight or less for a diagnosis of anorexia; in future, if the changes go through, the criterion will be "restriction of energy intake [leading to] markedly low weight." This rightly shifts the emphasis from the rigid weight characteristic to a pattern of eating and relationship with food. Now insurance companies will have a harder time cutting people off from treatment once they hit 86% of ideal body weight.
• Loss of menstrual period is no longer one of the criteria for anorexia. Some women never lose their period, no matter how thin they get; others keep menstruating even at very low weights.
• Bulimia will be diagnosable with purging episodes of once a week; right now, the criterion is two episodes a week.
• Binge eating is likely to become a diagnosable eating disorder.

New film: Fat

A filmmaker named Jennifer Jonassen sent me a link to this trailer for a new documentary, FAT, due out later this year. I think it looks pretty interesting. What do you think?

"You're so fat!"

The car was a beat-up sedan crammed with college kids--guys--who had clearly started their Saturday night partying on Saturday afternoon. My husband and I were out for a short three-mile bike ride. I heard the guys yelling and carrying on from a block away, and I knew they would yell something at me. And they did.

"You're so fat!"

As I pulled up alongside my husband, he asked, "What did they say?" When I told him, his jaw dropped.

"I can't believe they would say something like that!" he fumed.

I could. And as I told him, it didn't bother me all that much. I'm used to it. Guys have been yelling things at me since I was 15. Like any woman, I've learned to tune it out. It's a power trip, a form of misogyny, a reminder that women are vulnerable to men in a variety of ways.

Still, I thought about it all the way home. It reminded me of the way boys at my junior high school used to drop pennies on the ground, and yell "Kike!" at anyone who picked one up. And with that recollection, I realized viscerally, profoundly, and in a deeply emotional way that what those guys in the car were doing has a name: hate speech.

And although I've been thinking and writing and talking about this subject for years, I think this was the first time I truly got it in a fundamental way. And that is something I'll be thinking about for weeks to come.

Book trailer

A very talented student at Newhouse, Shelby Hadden, created this trailer for my forthcoming memoir, BRAVE GIRL EATING: A FAMILY'S STRUGGLE WITH ANOREXIA. Isn't technology great?

Let me know what you think.

One more reason NOT to get bariatric surgery

Bariatric surgery--the practice of deliberately mutiliating the gastric anatomy in order to lose weight--is being pushed harder than ever these days. The latest claim: it cures Type II diabetes instantly.

Not so fast. Apparently the issue is more nuanced than that. Researchers at the University of Washington recently found that people whose fasting blood glucose levels came down after having the surgery were still spiking diabetes-level glucose levels after meals.

The money quote:

"I don't think the procedure cures whatever it is that's causing diabetes in the first place," said Arthur Chernoff, MD, chair of endocrinology at Albert Einstein Medical Center in Philadelphia, who wasn't involved in the study.

SHocking, isn't it? Fat may not be the only cause of diabetes.

In fact, the weight-diabetes link is one of doctors' strongest arguments against fat acceptance and health at every size. Bariatric surgery is very serious business--and I mean that in both senses of the word. It's a multimillion-dollar industry based on the premise that it's a good idea to take out part of your guts--forever. Once you've had the surgery, your body is unable to process nutrients the way it used to. You may or may not become thin (some people lose weight only to regain it after); you may or may not experience some of the serious complications of the surgery; you will be permanently malnourished.

And now you may not have an instant cure for Type II diabetes after all. Because the equation may be a bit more complex than fat = bad, thin = good.

Bravo to Gawker

That sound you hear? It's me clapping for this tell-it-like-it-is piece from Gawker, which deftly skewers the mainstream media's not-so-hidden obsession with thinness.

My favorite quote:
The purpose of working out is get in shape. Not to get "thin." To be in shape, for the average person, connotes being healthy, and improving on the basic elements of one's own fitness: muscular strength, endurance, cardiovascular, flexibility, etc. . . . designing a workout and nutrition program with the goal of being thin will almost certainly ensure that you cannot achieve a high level of fitness; you would eat a low-calorie diet, thereby robbing yourself of muscular gains.

Note that I deleted a sentence or two in here. Even Gawker falls prey to the knee-jerk obesity-is-bad syndrome. (We really have to have a chat about that, Nick Denton.) But it's not so easy calling out the Gray Lady herself on the assumptions and obsession with thinness. So kudos to Gawker, and Hamilton Nolan, who wrote this post. Let 'em know what you think.

Fat and thin: It's all in your brain?

A new report from Brigham Young University suggests that women may be hardwired to worry about body image. Using functional MRI scanners, which record which parts of the brain light up while it's engaged in a task, researchers have discovered that women's brains react differently than men's to images of fat and thin. Study subjects, who were all thin, passed a screening test for eating disorders and so were presumed to have no overwhelming body image concerns.

When women were shown images of overweight women and told to imagine that someone commented that they looked like the woman in the image, a part of their brains that engages in self-reflection lit up. When looking at the images, says Mark Allen, a neuroscientist at BU, "women are actually engaging in an evaluation of who they are and whether they are worthwhile as a person. Even though women might claim to be well adjusted and not care about body issues, subconsciously they might care."

But couldn't this be the result of the overwhelming socialization American women experience on the subject of fat? Would the brains of women in a different culture--a culture that didn't put so much value on the thin ideal for women—light up the same way?

I'm not a neuroscientist, but I wonder if this study is flawed. Or maybe I simply don't want to accept that there's a biological limit to self-acceptance on this issue.

I'd love to hear what you think.

Britney does Photoshopping

Kudos to Britney Spears, of all people, for releasing some before and after photos of herself--before and after airbrushing and photoshopping, that is. She's the latest in a trickle of celebrities doing this. It's a commendable effort, even if, as Jezebel rightly points out, the before images are still unrealistic, thanks to makeup, lighting, and other props ordinary women don't have when they look in the mirror.

Still, it's a start, a small stone rippling the surface of the unattainable thin ideal. Me, I'm hoping for the rockslide. Any day now.

Health Care for the Obese

A new study published today reports that overweight and obese patients get the same or better quality of health care than "normal" weight patients.

Researchers at the University of Pennsylvania say they looked at quality of care across eight performance measures among Medicare and VA patients, and found no difference in the kinds of treatments doctors prescribed for obese and non-obese patients.

According to a s tory on MedPage Today, "Performance measures included diabetes care management (such as lipid and HbA1c monitoring and eye tests), pneumococcal vaccination, influenza vaccination, screening mammography, colorectal cancer screening, and cervical cancer screening." The story goes on to quote one of the researchers commenting that while doctors do "harbor negative attitudes" toward heavier patients, that prejudice doesn't affect the quality of care delivered.

I think this is a pretty grandiose conclusion to draw from such a limited study, and the researchers themselves cautioned against extrapolating these results too broadly. To me, the study raises some interesting questions: Are doctors more tolerant of overweight vets and/or poorer patients? Is "quality of care" strictly a function of which treatments are recommended?

I don't think so. I wonder what the patients would have to say about the quality of care they received--not just the treatment recommendations (which are of course important) but the relationship they had with their docs, and how it affects their long-term care. I wonder whether these two populations typically have long-term relationships with the same doctor, or whether they often see a revolving cast of medical providers, and whether that might make doctors react differently to them than to patients they see regularly.

Thoughts?

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.