Six-year-olds and eating disorders

This Canadian article, published last November, is one of the few I've seen anywhere that overtly links comments and teasing about weight with eating disorders. A significant percentage of teens with eating disorders are overweight at some point. As this piece points out, other people's responses to their weight can start them spiraling down into the hell of an eating disorder.

"Research shows that when girls are teased about their size and their shape, they stop eating," says Mary Kay Lucier of the Bulimia Anorexia Nervosa Association (BANA).

Notice that she did not say "when overweight girls are teased." That's the part that gets me. The act of teasing and making fun of a young girl's weight, even if it's "all in fun" (a phrase I loathe), can be enough to trigger self-starvation in some kids.

Lucier went on to say, "We've had 25 seven-year-olds in the past year come in in a state of acute starvation." I can imagine all too well what lies ahead of some of these girls. It's not pretty. Not at all.

BANA runs education programs, but its budget (like so many nonprofits') has recently been slashed. If you feel motivated to give away a little money in a good cause, download a donor form here.

Maybe the best thing all of us can do is teach our children that just as it's not OK to touch someone who doesn't want to be touched, it's also not OK to comment on anyone else's body--positively or negatively. We have better things to talk about.

Parent support group meeting in Madison, WI

UPDATE: This meeting has been postponed due to weather. It will now be held Tuesday, 1/20, at 7 pm at Starbucks.

The monthly Maudsley parents support group meeting in Madison will take place this Wednesday, January 14th, at Starbuck's, 3515 University Avenue, beginning at 7 p.m.

This is a fabulous get-together of parents who are in various stages of family-based treatment and who cheer each other on, help each other problem-solve, and support each other through one of the toughest experiences a parent will ever go through. If you're helping a child through anorexia or bulimia with FBT, you might feel like you don't have time for something like this. But try to find the time--it'll help keep you going through the tough moments. And as we all know, there are plenty of those.

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

Obesity problems--true and faux

An anonymous reader posed a question to me on another thread, which I thought deserved its own thread. He or she wrote:

I've been reading your blog on and off for about 8 months now. Do you ever recognize that there is an obesity problem in the States? Though I am on board with the message that 'fat' does not equal 'unhealthy,' and I am certainly opposed to pathologizing a group of people who have nothing wrong with them, I still believe there is an obesity-related health problem in this country.

In public, I feel I need to be an advocate for fat acceptance (or maybe, Health at Every Size), but I also want to find a way to acknowledge and distinguish the obesity-related health problem that does exist. I'd love to hear your thoughts about how to address this with an even hand.

I'm not an epidemiologist; I haven't done any studies on this question. I've read extensively, I've thought about it, I've talked to people. I'll tell you what I think, personally, and then I'd like to hear from other readers who may know more than me.

What I've read suggests that there is no obesity explosion in this country. That in general Americans are a little heavier than they were, say, 50 years ago. They are also a little taller. Some of what I've read suggests that these two go hand in hand. I know that there was a surge in obesity statistics about 10 years ago, when BMI cutoffs were changed overnight. People who went to sleep merely overweight woke up obese, and an alarming new statistic was born.

I've read research suggesting that weights went up in the late 1980s, after several years of the low-fat craze. Which brings me to the point here: While I don't think we can say with any certainty that people are fatter now and/or why that might be, what we do know is that we can't make them thinner. So let's set assume for a moment that yes, people are fatter now. Let's take it a step further and proclaim that this rise in weight is a Serious Health Problem (and I'm not saying it is; as others have pointed out very well, fat is not equivalent to poor health, and thin does not correlate good health).

Here's the thing: We can't change what people weigh. Some people lose weight for a short time by dieting. But 98 percent of them gain it back, and then some.

So diets don't work for adults. They don't work for children, either. School interventions are notoriously ineffective when it comes to making kids thinner.

Now let's go back to that assumption, that weight is a serious health problem. There is little to no evidence of this. There is a correlation between obesity and diabetes, but it's a correlation, not cause and effect. We don't know that obesity causes diabetes; maybe whatever malfunctioning metabolic shift causes diabetes actually causes obesity. In which case, trying to "cure" obesity would be like trying to "cure" OCD by, I don't know, strapping someone's hands to their sides so they can't obsessively wash them. It would be treating the symptom rather than the cause.

When it comes to other measures of health, the statistics don't bear out the notion that obesity is a serious health issue. In fact, Katherine Flegal's now-famous mortality study points to modest advantages to being "overweight," especially as people age.

So in answer to your question, Anonymous, no, I don't know that obesity is a serious health problem in the U.S., and neither do you, or anyone else, for that matter. We don't have enough information; we don't even really understand the information we've got. Losing weight sometimes raises people's risk of dying from cardiac disease, in fact. We just don't know.

While we don't really understand all the implications of weight, we do know that fitness is good. Eating a varied diet that includes (but isn't necessarily limited to) fresh fruits and veggies is good. Exercising (but not to the point of obsession) is good. Feeling good about yourself is good (and feeling bad about yourself is bad for you).

So until I know more, really know more, I'm going to stick to my guns on this one. Eat well. Live well. Move your body. And, most important, love yourself as you are right now. Not 20 pounds from now but today, this minute. Self-loathing--the kind that is a natural consequence of the current anti-obesity hysteria--is far worse for people than extra pounds. As far as we know.

The Maudsley Institute

It's not really called that, but that's how I think of the new training program for Maudsley therapists, organized and run by Drs. Daniel le Grange and James Lock, co-authors of Help Your Teenager Beat an Eating Disorder. Its official name is the Training institute for Child and Adolescent Eating Disorders, and it aims to do something incredibly important: train therapists to do true family-based treatment.

Right now, many families in the U.S. who want to use family-based treatment to help their children recover from eating disorders face the unhappy choice of trying to go it alone, drive many hours to see a Maudsley therapist, or go with a different treatment. FBT is hard--the hardest thing most families will ever do. They need support. But at the moment, there just aren't enough true Maudsley providers to go around.

Maybe more important, families have no way to tell the faux Maudsley providers from those who truly practice and believe in FBT. There's a surprising number of therapists out there who say they practice Maudsley but who've given it their own unfortunate spin, like this one. And there are outpatient and inpatient programs who claim the same. Too often, what they're doing is NOT true FBT.

Lock and le Grange's new institute will put the seal of approval, as it were, on professionals who not only train with them but actually practice true FBT. This is good for everyone: Providers will get more training from the folks who know the treatment best, and families will have a measure by which to judge quality and competence of potential therapists. It's win-win.

The first training will be held February 27-28 in Palo Alto, California. It will take some time to "graduate" the first group of Maudsley therapists. Personally, I can't wait. Thanks to Drs. le Grange and Lock for doing this.

What do YOU do?

So I'm sitting at brunch with some neighbors--new neighbors, people I don't yet know very well but whom I like a lot--and the subjects of eating disorders and weight come up, as they inevitably seem to do. It is just after New Year's, after all, and we are sitting at brunch--a feast of a brunch, actually, with omelets and homemade waffles, a big bowl of whipped cream, berries, lox, roast potatoes, clementines. Everything is delicious and there's plenty of it.

So of course the conversation turns to dieting and New Year's resolutions, obesity and anorexia. And in the space of about 5 minutes I hear pretty much every myth about eating and weight there is:

"Children are much much fatter today than they've ever been and we have to do something about it."
"There's an explosion of diabetes among children today."
"Anorexia--that's all about control, isn't it?"
"Anorexics are doing that because they want to be thin. It's a cultural pressure kind of thing."

As I've said, these are people I like but don't know very well. But I can't just keep my mouth shut. I can't. I try to maintain a reasonable facade but within minutes I'm arguing, spouting statistics and opinions, trying to keep my voice friendly, hearing the urgency in my own words. I explain that one reason for the so-called explosion of obesity in America (among adults as well as children) is that the cutoffs for overweight and obesity changed overnight, so millions of people woke up one morning and were suddenly considered overweight or obese. That while more children are diagnosed with diabetes now than, say, 30 years ago, some of that number is certainly due to increased awareness and earlier diagnosis, which is a good thing. That the numbers don't differentiate between cases of Type 1 diabetes, which is largely genetic, and Type 2, which is linked to diet and activity.

I tell them about Health At Every Size, and try to conjure as many of Deb Burgard's talking points on size acceptance as I can remember. I tell them that Tom Cruise has been considered obese according to the BMI charts.

I tell them that no, anorexia is not about control, that it's not "about" anything except having the shitty luck to be genetically vulnerable. I tell them that for a person with anorexia, eating is like--oh, I don't know, maybe jumping out of a plane without a parachute. Covered in writing snakes. Giving a lecture on the way down. That for some people, restricting (aka dieting) sends them straight down the rabbit hole, that anorexia distorts thoughts and perceptions and feelings, that it's not a question of just picking up a fork and eating.

One of my new neighbors is in medical school. She's particularly interested in these subjects because she will have to adopt a professional attitude about them sometime soon. She'll have to figure out what she thinks and how to talk to people on all parts of the weight and eating spectrum--her patients. She listens. Everybody listens. We actually have a lively and interesting conversation. I think.

But I lay awake last night replaying it in my mind, wondering if I should have taken a different approach to the discussion. It's not so much that I think I was obnoxious (though maybe I was, a little) as it is the fact that I find these conversations exquisitely painful. Every time I hear the words It's all about control, isn't it? it's like some synapse in my brain starts overheating. How do I offer my knowledge and opinions without being obnoxious or driving myself beserk?

What do YOU do when the conversation turns to subjects like this?

OT: Clearing the air on Kawasaki Disease

My heart goes out to John Travolta and his family for the loss of their 16-year-old son, Jett. What a devastating nightmare to lose a child. Any parent who's faced a child's mortality can empathize, I'm sure.

The Travolta family blames Jett's childhood bout with Kawasaki disease. We won't know for sure what happened until the autopsy is complete. But I'd like to clear up a few misconceptions about KD, as it's called, in the meantime

Kawasaki disease is a full-body vasculitis, meaning that blood vessels all over the body become inflamed. That's why the whites of the eyes turn red, along with the the soles of the feet and palms of the hands and the tongue. The heart, of course, is vascular, and it, too, becomes inflamed and can suffer permanent damage. KD affects mainly babies and toddlers of Japanese descent, and is often not diagnosed quickly. Children can indeed wind up with scarred and damaged hearts.

My younger daughter, Lulu, had KD when she was 8 years old. Luckily, a pediatrician recognized and diagnosed it promptly. Lulu spent 5 days in the hospital on intravenous gamma globulin and months convalescing at home. Today, at 13, her heart is fine.

No one knows what causes KD--and believe me, people have speculated galore. The Travoltas have been convinced for years that Jett's KD was caused by carpet cleaners. That's one of the theories that's circulated about it. I don't buy it, partly because hey, we never clean our carpets. KD is statistically more common in the winter and early spring (Lulu came down with it in January); maybe there's a correlation because people clean their carpets more in winter. I wrote a piece on KD for the New York Times and talked to all the leading researchers on it. They don't buy the carpet cleaners theory, either. It's more likely to be related to Staphylococcus aureus (Staph A) or toxic shock syndrome.

There is absolutely no evidence that KD causes autism. Repeat: KD does not, to the best of our knowledge, cause autism.

Of course there's a lot we don't know. We don't know that Jett Travolta was autistic, and frankly, it's none of our business. But we do know that kids who have had KD do not typically wind up with seizure disorders or autism.

I'm thinking of the Travolta family in their grief and loss, and hoping that Jett's death doesn't add to the misconceptions around Kawasaki disease. Maybe this well-publicized incident will inspire some researchers to get on the stick. There's been very little research done on KD. How about it?

Support Project Feed Me

One aspect of food and eating that I rarely write about is the fact that many people in this country and elsewhere go hungry because they're poor. Now an enterprising group of Syracuse University freshmen is trying to do something about that.

Project Feed Me is designed to not just feed the hungry but to inspire young people to get involved with community projects. The group's founder, Patrick J. Alvarez of New York City, has organized turkey dinners in Harlem, banquets, and basketball tournaments. Now the group is looking for the next level of support, including corporate sponsors and partners, volunteers, and donations.

You can do something to help right now with just a click of your mouse. The group is in the running for a grant from Best Buy.All you have to do to help it win one is click here every day and vote for Project Feed Me. You'll also find out about some of the other cool projects up for grants, and since you have to vote for 2 every day, you'll have a chance to support some other groups as well.

My metaphorical hat's off to Mr. Alvarez and the rest of the PFM group, for doing more than sitting around talking about it. They're walking the walk. Give them a hand, won't you?

Looking your best: One writer's (tongue in cheek) advice for dealing with the "obesity epidemic"

Pieces like this are just part of the reason I love the New Yorker magazine. Much better than the cartoons, IMO.

Enjoy, and happy new year!


Thanks to Caylin for the link!

Join a study, help yourself and others

In the spirit of the new year, here's a list of ongoing treatment studies looking for subjects. Joining a study is one way to not only contribute to the still-infant science of eating disorders treatment, but also get excellent treatment for yourself and those you love--for free.

May 2009 be a year when eating is a pleasure and not a terror or trouble to all of you.


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

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

Maryland - Bulimia Research Study: The Johns Hopkins Eating Disorders Program is seeking women 18-40 years old with bulimia nervosa interested in a research study funded by the Klarman Family Foundation. The study includes a health assessment, blood testing and pictures of the brain taken using a medical scanner. Eligible women will be paid up to $400 for their participation and will be offered 6 weeks of outpatient treatment. Call 410-955-3863 or see this site for more information.

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

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

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

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

North Carolina: The University of North Carolina's Eating Disorders Program announces a new clinical psychotherapy trial for bulimia nervosa. This study is comparing two different ways to deliver cognitive-behavioral therapy. (CBT) which is the treatment of choice for bulimia. Patients will be randomized (like a flip of a coin) to either face to face group CBT or internet-delivered CBT with a therapist-moderated chat group. There is no cost for participating in this trial. Eligibility Requirements: Male or Female, at least 18 years old, have a home computer with Internet access. Contact the Research Coordinator at 919-966-2882 or cbt4bn@unc.edu for more information.

Happy merry to you!

I thought this study might be a fitting gift of the season to my blog readers. Because Feed Me! is about more than nutrition and eating--it's about feeing yourself spiritually and emotionally as well.

Enjoy--and happy new year!

Say What?

This poll from CBS has to be one of the weirdest things I've read in a while. It reminds me of the kind of question you'd ask at an 8th-grade sleepover: Which is worse, burning to death or freezing?

I point it out because one of the questions asks,, "What's worse, being obese or suffering from anorexia nervosa?" Take a guess how "people on the street" responded. The pollsters go on to explain that 20 percent of anorexics die from the disease, whereas a 25-year-old obese woman has only a .01 percent chance of dying.

Other questions included comparisons between smoking pot and cigarettes, between having a swimming pool and a loaded gun, and between being married and miserable or single and happy. Each time there was a "counterintuitive" answer. People were apparently surprised to learn that anorexia is deadlier than obesity, that having a swimming pool is more dangerous to your family than keeping a loaded gun, and so on.

Weird, but maybe useful.

The "obesity tax"

I thought about posting on this a few days ago, when Governor Paterson first proposed a tax on non-diet soda, and decided that other folks had tackled it ably, so no need.

Tonight, as I was listening to yet another commentator go at this issue on NPR, I thought about my friend P., who became diabetic a couple of years ago, stopped eating sugar altogether, lost 30 pounds, and nearly blinded herself cooking with Splenda. She used it in a dish she cooked on the stovetop and leaned over the pot at just the wrong moment. Splenda, it seems, contains chlorine, and apparently some of that chlorine is released during cooking. P. got a faceful of it and went temporarily blind. Luckily she got her vision back.

I thought about the long-running debate over whether aspartame (the artificial sweetener in Equal and NutraSweet) causes cancer. Well, actually, it does cause cancer in lab rats; the question is whether its carcinogenic properties extend to humans, and at what levels/doses. When I was growing up, my mother and grandmother and pretty much every grown-up woman I knew kept a little enameled or cloisonne pill holder in their purses. I used to beg my grandmother to let me use the tiny tongs that came with hers to drop sacccharine pills into her after-dinner coffee. My grandmother died of lymphoma, probably more closely related to her years of smoking than to her saccharine intake. Or was it?

I think Governor Paterson's tax has more to do with New York State's budget deficit than anything else, but I still have to wonder whether he thinks it's better to risk blindness or cancer than fatness. Remember that study where nearly 90 percent of people surveyed said they'd rather be blind than fat? I guess Governor Paterson has his finger on the public pulse after all.

New stuff at MP.org

If you haven't visited the Maudsley Parents site in a while, take a look. We've posted lots of new content, including a wonderful video interview about anorexia with Dr. Daniel le Grange of the University of Chicago, done by our own Jane Cawley. There's also new information in Spanish, a new article on eating disorders in boys, an updated and downloadable recipe collection, a video interview with Dr. le Grange on bulimia, and more. Plus there's a new search feature on the site.

Stop by and let us know what you think! Kudos to Jane Cawley for the new content and organization, and to Ann Farine, our web designer.

What I said

Nearly a year ago I wrote a post about Oprah's public battle with weight. Back then I wondered whether anyone could "win" the "battle of the bulge," if Oprah with all her money and resources couldn't.

Now the comment is a bit different: If Oprah, with all her ups and downs, her struggles to accept herself as she is, her repudiation of her body and her appetite, can't learn to love herself, then who can?

The answer: You can. I can. Even Oprah can.

But to do that, you've got to let go of the fantasy image of yourself as you wish you were.

You've got to grieve for the vision of yourself you've held dear for so long. You've got to grieve for that perfect you, the one who floats effortlessly through the world, svelte, unsinkable, emotionally airbrushed. You've got to learn to love instead what you've got: your thighs and your big heart, your dreams and your pores, all of them part of the same imperfect and vastly more interesting package than any airbrushed toothpick-thin fantasy could ever be.

Oprah, if you're reading this, I'm rooting for you--not to lose that weight again, but to gain something infinitely more precious: yourself.

Round-up time!

I've been a Very Bad Blogger recently, for which I am deeply sorry. :-) Here are a few tidbits to tide you over until I can come up with a brilliant new post.

First, 3 new studies looking for participants:

The Mount Sinai Eating and Weight Disorders Program is offering study treatment as part of a federally funded study (Principal Investigator: Katharine Loeb, PhD) for children and adolescents with symptoms of anorexia nervosa. If your child is 10-17 years old, is medically stable, and is developing signs and symptoms of an eating disorder, s/he may be eligible to participate. The study is approved by the Mount Sinai School of Medicine Institutional Board (Protocol 04-0978, approved through 8/31/09). For more information, call Lauren Alfano, 212-659-8724.

The University of Chicago is looking for adolescents with bulimia nervosa and their families for participation in a 6-month outpatient treatment research study. (Principal Investigator: Daniel le Grange, PhD) The purpose of this research study is to identify effective outpatient psychological treatments for adolescents with bulimia nervosa.
To be eligible the child must be between 12 and 18, be living with at least one parent, and have a diagnosis of bulimia nervosa or partial bulimia nervosa. Participating families will engage in 6 months of outpatient therapy for bulimia nervosa at The University of Chicago Hospitals. These treatments have the potential to bring about improvement in eating disorder symptoms. For more information, please call the bulimia nervosa treatment study at (773) 834-5677, email bulimia@yoda.bsd.uchicago.edu, or visit the Treatment of Bulimic Adolescents Study webpage.

The Johns Hopkins Eating Disorders Program is looking for women 18-40 years old with bulimia nervosa interested in a research study funded by the Klarman Family Foundation. (Principal Investigator: Angela Guarda, MD.) The study includes a health assessment, blood testing, and pictures of the brain taken using a medical scanner. Eligible women will be paid up to $400 for their participation and will be offered 6 weeks of outpatient treatment. Please call (410) 955-3863 for more information.


Next, mark another milestone in the Fight Against Good Foods/Bad Foods: Researchers in Spain have found that a handful of nuts added to your diet each day lower cholesterol and other cardiovascular risk factors. Whether this will actually decrease heart attacks and strokes is anybody's guess. The good part from my POV is that it moves nuts back out of the "bad food" category. Someday, somehow, we will abolish those categories . . . and this is a step in the right direction.

And finally, a shameless plug for my upcoming anthology, Feed Me!: The first review is in, and it's a good one, from Booklist. To see it, join the Feed Me! Facebook group--I've posted it there.

Send me your food/eating/body image news to get me through the grading of final projects. Thanks!

This is the way we legitimize fat prejudice

My local paper, the Syracuse Post-Standard, is really pretty good, especially for a small city paper. Like many small papers these days, it picks up a lot of stories from wire services. Today's post concerns one of those wire stories,which ran in the feature section as "10 simple things you can do today to improve your life."

Number 3 on the list is "Put one foot in front of the other." It's a plug for exercise, specifically for walking, which I am in favor of, and advocates getting a pedometer to measure your steps. We're all supposed to walk 10,000 steps a day. I'm good with that. But halfway through the item I came to this sentence:

Those in the obese range usually take between 4,600 and 6,000 steps a day, overweight people walk 6,000 to 7,000 steps a day, and those of normal weight tally 8,000 to 10,000 steps a day.

Where to begin: With the idea that anyone who's not overweight is "of normal weight"? (Since when is being underweight normal?) Or with the random declaration that obese people walk no more than 6,000 steps a day?

I've worn a pedometer, and I've typically taken between 7500 and 9,000 steps a day. I have to make a conscious effort to reach 10,000 steps a day, it's true, but according to this article, since my BMI is in the obese category, I should be more of a couch potato.

It's just another example of how silly these kinds of "health" stories can be. And as a member of the media myself, I really shouldn't get exercised (pun intended) about ridiculous things like this. But I do. Because every one of these stories underlines, subtly or overtly, our cultural attitudes and assumptions about fat people, and so leads to more fat prejudice and stereotyping.

And there's already plenty of that to go around.

Wanted: Snappy comebacks

It's inevitable: Whenever I see people I haven't seen for a while, one or two of them are sure to say something like "You've lost weight! You look so good!" Not because I've lost tons of weight. Maybe I've lost 5 pounds, but I really don't know (and don't care) and haven't weighed myself in months. I think it's because I'm happy. Oh, and my hair is longer.

The point is, I wish I had something to say in this situation. Yesterday an acquaintance gushed on and on about my putative weight loss, and I said, "No, I really don't think I've lost a lot of weight." Her response: "I beg to differ!"

Excuse me? You're telling me about my body? I know she meant well, but it was tres frustrating. I wish I had some snappy (but not snarky) comeback to offer in this situation.

Any suggestions?

Good Book, Bad Book

I can't wait till the latest round of kids'-books-to-combat-childhood-obesity passes. Each one seems more offensive than the last.

Today's review looks at I Get So Hungry, by adult fiction writer Bebe Moore Campbell, who died not long ago. I love Campbell's fiction--usually. But this book, like so many of its ilk, is nothing short of craptacular.

Its main character is a young girl named Nikky who is teased at school for being fat. Nikky is fat because she's a compulsive eater. She eats when she's sad, upset, angry, bored, and hungry. She eats junk food, and lots of it. When her adored and also fat teacher goes on a diet, Nikky wants to also, but her mother won't buy fruits and vegetables--not until she goes to a parent teacher conference and sees how skinny the teacher has become.

This book doesn't even pay lip service to the notion that people come in all shapes and sizes. It equates being fat with being emotionally dysfunctional and/or gluttonous. And it out and out lies: if you eat fruits and vegetables and walk every day, you'll lose lots of weight, according to the book. Oh, and come up with snappy putdowns for your tormentors.

By contrast, a wonderful book called Fat, Fat Rose Marie, by Lisa Passen, takes on the same subject matter--a little girl is teased for being fat--and handles it so much better. Rose Marie is befriended by another child who's the butt of teasing, because she has red hair and freckles, and together they empower each other and teach the other children to look beyond the surface to the person within. Rose Marie is never shown shoveling in food, as Nikky is; nor is she emotionally dysfunctional. She's just fat.

Lisa Passen's book was published nearly 18 years ago, proving once more that we're in a kind of Dark Ages when it comes to body image and weight. I can only hope we'll emerge sooner rather than later into our Renaissance.

What exactly is "moderate" exercise?

That's the question posed by a study in progress being done at the State University of New York and Syracuse University.

The Surgeon General recommends that everyone get 30 minutes a day of moderate exercise--but what, exactly, does that mean? Language is powerful but not always specific; what feels moderate to you might feel excessive to me, or maybe underwhelming.

Researcher Cameron Hall set out to explore people's perceptions of moderate exercise. I was lucky enough to be able to volunteer for the study, and it's been fun. On the first visit, I came into the lab, where they hooked me up to all kinds of monitors and meters and put me on a treadmill to measure my maximum exercise tolerance. They measured my oxygen consumption, heart rate, and perceived levels of exertion with one of those little charts where they ask you to point to how hard you think you're working. Pretty damn hard, by the end.

On the next visit, I was asked to walk around a track at what I thought was a moderate level of exercise. I booked it, let me tell you, wanting to surpass the researchers' expectations of me. I walked much faster than usual, averaging around 4 miles per hour instead of my usual 3.7. On the third visit, we were back in the lab, only now the researchers were telling me how fast and hard I had to work to hit the middle part of my range by the numbers.

It turned out that what I think of as moderate is nowhere near what the numbers say. Visit 3 was excruciating because we had to keep the treadmill flat for comparison purposes to the track we used on visit #2. I had to walk 4.2 miles an hour and even then could barely get into my moderate heart and oxygen consumption ranges. This might not have been a problem if I were, say, six feet tall. But I'm just about five one, and my legs just aren't that long.

So I learned what I personally have to do to get in the recommended half hour of "moderate exercise": Set that treadmill at 3.8 and crank up the incline to between 3 and 5 percent. I did it yesterday, and let me tell you, I was working hard. And that's what the researchers think will be the upshot of the study: You probably can't protect your cardiovascular health by strolling around the block with the dog or taking a leisurely stroll. You've gotta book it, baby.

What I love about this study is that it acknowledges both the power and pitfalls of language. Words are imperfect vehicles for expressing what we feel and what we know. But they're all we've got. Sometimes our task is to learn to use them more expressively. Sometimes, as in this case, our task is to connect them to cold hard facts.

The study results should be published within the next few months. I'll keep you posted.

Feed Your Head

It's official: You can pre-order my new anthology, FEED ME: WRITERS DISH ABOUT FOOD, EATING, WEIGHT, AND BODY IMAGE at Amazon. Yay!

I'm excited about this collection, if I do say so myself. There are some tremendous essays in here, from writers like Amity Gaige, the ever-hilarious Laurie Notaro, Caroline Leavitt, Ann Hood, Joyce Maynard . . . and, yes, yours truly. And they cover just about every aspect of our relationship with food. Plus the collection got awesome advance praise from Mary Pipher (one of my favorite writers), Betsy Lerner, Ellyn Satter (another one of my faves), and Nancy Redd.

Random House is producing a digital excerpt, with the introduction plus three essays. I'll load it onto the blog when it arrives.

Stay tuned. . . .