There is no way to prevent anorexia

As I wrote the title of this post, I felt a wave of despair. Until a couple of days ago, I had never put this thought into words, never articulated it to myself. But it's true.

Two years ago I would have said of course you can prevent anorexia. I certainly never believed my daughter would develop it.

She was smart. She was funny. She was self-aware. She was eminently rational, and had been since toddlerhood. She watched no commercial TV. Her videos were carefully screened. She was a feminist before she started kindergarten.

Every kid in her sixth-grade class had to do a research paper on a subject of interest. She did hers on eating disorders. Looking back, I understand that that right there was a clue. At the time, I thought it made her safer because she had knowledge, she understood, and she was warned.

I thought that years of modeling a healthy attitude toward my own body would protect her. (I was fooling myself there, too, but I tried hard.)

But here's the thing: Nothing that she did or I did protected her from anorexia. Because there is no way to prevent an eating disorder.

If anorexia could be prevented, we wouldn't need to be talking about treatment. We wouldn't need to watch children suffer or families unravel.

I know from my own daughter's experience that knowledge does not prevent anorexia. She knew more about anorexia in sixth grade than many doctors do. She understood the dangers. More, she knew she was--as a gymnast and perfectionist--at risk. But it didn't help.

I'm all for the studies now being done on treatments for anorexia. They're long overdue. But where are the studies on prevention? Why is no one even asking the question of how to prevent anorexia and bulimia? Cynthia Bulik has looked at anorexia and twins--this would seem to be a perfect area of research for her.

We know that genetic predisposition plays a huge role in eating disorders. We know that environment can be a catalyst. How does the famous saying go? Genes load the gun and environment pulls the trigger. What we don't know is how to put the safety back on the gun. We'll never know until we start the scientific process of figuring it out: coming up with hypotheses, testing them, recording the results, making connections.

I've watched half a dozen young women I know--all of them bright, funny, well-read, engaging--fall prey to anorexia. I can look around at the young teenagers I know and predict, now, who's at risk. It's like watching a train wreck in slow motion.

Treatment is crucial. God knows we need better treatments for anorexia. Maudsley treatment is the best we've got so far, and it saved my daughter's life. I'm grateful. But it's not enough. Enough is when we can keep kids from becoming anorexic in the first place.

I don't have the answers. Maybe it's a combination of things: a vaccine, education, behavior modification in those at risk. I don't know. But I do know that until we start asking the question, we'll never find an answer.

Clinton's crusade

Bill Clinton's new crusade against obesity is making headlines and blogs around the world. The media just can't resist the image of a formerly fat former president calling for more ammo in the war against obesity.

If only Clinton would harness his power for good--imagine what he could accomplish!

Don't get me wrong--I'm an FOB (fan of Bill's) from way back. But I sure wish he'd take a stand for something truly meaningful, like national health insurance or truly meaningful mental health parity. Or how about pushing for an hour-long school lunch, like the French have? Or daily recess for all schoolkids?

And hey, Bill, as you wield your influence for the good of children everywhere, I hope you will take the time to educate yourself about eating disorders. I hope your efforts stay focused on supporting children's health in all ways rather than fat-bashing--which we all know is ineffective at best and cruelly destructive at worst. I would hate to see more of what helped trigger my daughter into food restricting and, ultimately, anorexia: mindless labeling of "good" foods and "bad" foods, fear-mongering at the table, and more prejudice against those who don't conform to cultural ideals.

The Missing Link

In the lexicon of sensationalized news stories, there are none quite as poignant as stories like this headline from the Times of London: "15st boy is taken from grandparents who lost their daughter to anorexia."

The story goes on to describe, in horrified tones, how a 10-year-old Spanish boy was removed from his grandparents' custody after they overfed him until he reached 200 pounds. The story goes on, predictably, to quote experts familiar with the case as well as those who were not about the dangers of obesity, how obesity is on the rise, etc. etc.

Buried up near the front of the piece is a crucial nugget of information, mentioned once and never referred to again. The grandparents had custody in the first place because the boy's mother had died of anorexia.

It's tragic that no one quoted in this story (and for all I know, in the boy's life) has made the connection between his mother's death from anorexia, his grandparents' feeding behavior, and his own eating. Imagine watching your daughter or your mother starve herself to death. Imagine the grief, the guilt, the disbelief and lack of understanding. Of course that has an effect on everyone's relationship to food.

Authorities took the boy away from his grandparents and put him on a diet. They report that he has now lost more than 20kg and that they'd like to return him to his grandparents' custody. The story goes on: "But they say the grandparent remain “in denial” that their feeding habits are a problem – health officials said that they even tried to smuggle chocolate biscuits to him during their weekly visits. “The problem is that the grandparents still don’t understand that they were harming the lad and seriously placing his life and future at risk,” Ms Fernández said."

What will it take for us to look at the relationship with food and eating as a whole package and not isolated bits of pathology? My heart goes out to this boy and his grandparents.

Listen to Mr. Wrong

Yesterday I was interviewed by Deborah Harper of Psychjourney about MR. WRONG: REAL-LIFE STORIES ABOUT THE MEN WE USED TO LOVE. She was one of the most thoughtful interviewers I've come across, and I'm pleased with how it turned out.

So just in case you're interested, I'm going to try to post the link to the interview here. You can always email me and I'll send you the MP3 file if this doesn't work.

To Diet or Not to Diet?

Just in case you were wondering, the answer is pretty clear: Diets don't work. But then we all know this already, don't we?

Part of my daughter's recovery from anorexia has been to reconnect with her own feelings of hunger and fullness. For a long while she never felt hungry--or at least, she never felt a physical sensation she could identify as hunger. I think she was very hungry underneath the anorexic mind that temporarily took over hers. The most emotional moment of her recovery was the day she called me at work to say, "Mom, I'm hungry!"

I've never been anorexic. But I, too, had to learn to feel hunger again after years of training myself not to. I had to experience the scary feeling of being hungry and reassure myself that I would eat, that I would feed myself--and that I would stop eating when I wasn't hungry anymore.

I grew up dieting and binging. That's what we Jersey girls did in the 1960s and 70s, especially if our mothers lectured here. And while I never unearthed a treasure like this one, I did effectively divorce myself from every feeling having to do with food.

Too bad I couldn't divorce myself from the self-loathing that dieting--and falling off the diet--regularly imposed.

Whichever end of the spectrum you approach it from, dieting looks pretty lame. It's a multi-billion-dollar industry, and that's why it still has street cred, despite the crummy statistics around its efficacy--only 2% of dieters keep their weight off, according to the UCLA researchers.

I feel the same about dieting as I do about using illegal drugs: I sure wish I hadn't done that when I was young and naive and ill-informed.

So those of you who might be on the fence about it: Just say no.

Of pregnancy and fat phobia

Another post from Sandy Szwarc highlights the peculiar and dare I say twisted mentality that comes from living in a culture that's fat phobic in the extreme. Szwarc's talking about the latest media anti-fat media blitz, this one focused on the relationship between weight gained in pregnancy and overweight toddlers. Specifically, according to the study's authors, women who gain even the accepted amount of weight during pregnancy run four times the risk of having a child who's overweight at age 3.

Scary, huh? Apparently much scarier than another finding buried in the study, which received neither headlines nor any media attention: the fact that women who didn't gain enough weight during pregnancy had double the risk of having a baby with intrauterine growth retardation. According to Szwarc, Babies with IUGR are at vastly higher risks of stillbirth and serious medical problems during infancy if they do survive.

This reminds me of the recent study published in the New England Journal of Medicine, which found that being underweight or of "normal" weight (and let's not even go there for now) correlated with higher rates of mortality than being overweight. (Thanks to Paul Campos for writing about this!) This unpopular finding has been scrutinized and rationalized to death, because apparently it's unbelievable that having nutritional reserves (i.e., being fat) could possibly confer any health benefits.

This, in turn, reminds me of the way doctors and therapists who treat eating disorders sometimes fall inadvertently into the language and perspective of those eating disorders. How people with anorexia can walk around at weights that are dangerous, yet no one notices because we've been so conditioned to think that thin = healthy and good.

Apparently we live in a culture where death is preferable to being fat. Even for babies. Even for toddlers.

Some years ago I dealt with this in my own life, after a severe depression sent me into a tailspin (what would have no doubt been called a nervous breakdown 60 years ago). Antidepressants lifted the fog and gave me my life back. They also, over a period of 5 years, led to a 50-pound weight gain. To me it was no contest: I'd rather be sane and happy and fat than thinner and miserable.

I wonder how many people would agree with me?

The Big O

A quick post this morning because I couldn't resist linking to the blog of Sandy Szwarc, whose smart, thought-provoking blog I love. Recently she wrote about the so-called obesity "epidemic" in a way that had me cheering from the sidelines.

This follows on the heels of my pulling my sixth-grader out of her required "wellness" class, at least for the nutrition and "obesity" parts of the class. Because isn't it a great idea to take a bunch of impressionable 6th-graders and brainwash them into thinking that the only healthy food out there is a carrot stick or salad (hold the dressing!)? Given the fact that most eating disorders start between 11 and 17, this seems like a bad idea to me, especially the way such things are taught. But don't take my word for it--read Sandy Szwarc's blog. Great stuff.

Mental health parity

Here in Wisconsin, we don't have mental health parity, a fact I often moan about. If only we had it, I often thought during my daughter's recovery, we would be able to get the treatment we need for anorexia, bulimia, and other eating disorders.

Parents in New Jersey, where there is mental health parity, found that insurers still discriminated against e.d. treatment, denying and disqualifying it in the face of medical advice. Dawn Beye is one parent who got sick and tired of waiting for her insurer to do the right thing and cover her daughter's treatment; she and other parents filed a class action lawsuit to have anorexia classified as a "biologically based illness." Apparently insurers in New Jersey differentiate between biologically based mental illnesses (depression, etc) and non-biologically based mental illnesses.

I guess they think anorexia is all in our heads. They ought to read NAMI's stance on this, not to mention the opinions of many other clinicians and professionals. But then we all know that health insurers know more than doctors when it comes treatment protocols and appropriateness. Right?

When I rule the world, we'll have national health insurance (which goes without saying). And that national health will cover evidence-based treatment for eating disorders, plus support families using the Maudsley method and other approaches yet to be discovered for helping their children recover from e.d.s.

Beye's daughter is still in-patient after 10 months. Beye and her husband still don't know how they're going to pay for her treatment. They could wind up owing several hundred thousand dollars if Aetna doesn't do the right thing and cover the IP treatment.

As my grandmother would have said, it's a shanda. And if you don't know what that means, look it up in Leo Rosten.

Anorexia and control

How many times have you read it or heard it: Anorexia is all about control. And its corollaries: People with anorexia have to choose to eat. Parents who try to make them eat have control issues.

Those of us who have used the Maudsley approach to help our children heal from eating disorders don't buy this. But the rest of the world still does.

I know a family that's had both kinds of treatment for their anorexic child. The mom put her finger on how each felt to her: "Anything less than Maudsley gets into really icky murky games. Maudsley is brutally hard but man it is all above board: parents want kids to eat. Period. What we've been doing instead is no less psychologically tense or painful."

That's exactly what I appreciate about the Maudsley approach: It's all right there out in the open. No hidden agendas, no submerged power struggles. Parents want their child to eat. They require it. They support it. Not out of a need to control, or boundary-crossing, or a wish to keep their child small, or any of the other accusations leveled at parents of anorexics.

We require our children to eat because we love them and want them to get better.

What could be wrong with that?

Eating disorders and self-esteem

The question I've been chewing on lately is this: What's the connection between eating disorders and self-esteem?

Does low self-esteem lead to, contribute to, or cause eating disorders? Conversely, does boosting self-esteem make one less susceptible to e.d.s?

I started thinking about this after following a link to an interview on Studio 2B, which bills itself as "a site for teens." The interview is with Scarlett Pomers, a 17-year-old actress who was treated for anorexia in 2005 and is now involved with the National Eating Disorders Association. In it, Pomers reinforces the link between positive body image, self-esteem, and health. She quotes some scary statistics--half of all girls between ages 12 and 14 say they're unhappy because they're too fat--and offers earnest suggestions for teens who may know someone with an e.d. or who may themselves be struggling with one.

All to the good. I do believe the more we talk about eating disorders, the less stigma is attached to them. But I'm not sure about the connection with self-esteem.

Before anorexia (and now again, as she's in recovery) I would have described my daughter as confident, smart, funny, outgoing, and emotionally astute. Her descent into anorexia did not seem connected with low self-esteem. On the contrary, she seemed to develop low self-esteem--along with a slew of other problems--only after becoming anorexic.

I don't want to knock efforts like NEDA's and others to try to boost girls' self-esteem. It's not a bad thing in this post-Reviving Ophelia culture. I'm wondering, though, if efforts like this are enough, or speak to the right point.

At the very least, shouldn't they be paired with education around nutrition--not the deluge of anti-obesity propaganda that now passes for "wellness education" but a clear, matter of fact explanation of what teens need to eat in order to be healthy? It wouldn't hurt to have a unit on, say, how and why diets don't work, too.

I don't know that this will prevent anorexia and bulimia in those who are susceptible. Maybe it would be a good start, though.

I would really like to hear what other people think on this subject.

Book review: Take Charge of Your Child's Eating Disorder

I really wanted to like Take Charge of Your Child’s Eating Disorder, co-written by Pamela Carlton, M.D., who directs Stanford University’s Adolescent Eating Disorder Parent Education and Support Program. I’m a huge fan of the work being done at Stanford by James Lock and nearby at UC San Diego by Walt Kaye. But after reading this, I want to ask them both, “How could you have let this happen?”

Families with anorexic or bulimic children need all the information and help they can get. But for the most part, they’re not going to get it here.

If I’d read Carlton’s book when my daughter was newly diagnosed with anorexia, I would have wanted to shoot myself, mostly because of statements like this: “Full recovery from anorexia is not easy, and many people struggle with ongoing body image disturbances and disordered eating behaviors throughout their lives. Fortunately, with early treatment, your child’s chance for full recovery is likely to be increased.” (p. 9) This leads parents to believe that their child will be dealing with an eating disorder for the rest of her life—which in many cases is simply not true.

In reality, there’s lots of hope for full recovery, especially among adolescents who are treated early with family-based treatment, also known as Maudsley treatment. Nowhere does Carlton mention this as one of the treatment modalities for eating disorders. Instead, she recommends that parents put together a treatment team—a good idea, in and of itself—and says, “The most important thing to remember is you cannot do this alone.”

Actually, you can do this alone, and sometimes you should. A treatment team is great, so long as everyone is on the same page. My husband and I assembled a terrific treatment team, but there were times, inevitably, when they contradicted one another or said just the wrong thing to our daughter. It’s certainly better to have no therapist than a bad one—and the vast majority of eating disorders specialists out there are bad, make no mistake about it. A third of them have or had eating disorders themselves, which tells you something right there.

Throughout the book, Carlton pays lip service to the idea that parents should be involved in their child’s treatment. But she doesn’t actually seem to believe it. Take this example she offers about a 15-year-old, Jinny, in treatment for anorexia. She writes that because Jinny was fixated on her weight, she did not give the girl her weekly weight updates. Fair enough. Then she writes, “But after each appointment, her mother would follow me out of the room with her notebook, ready to write down a weight, promising, ‘It’s okay, I won’t tell Jinny.’ I finally told her this was not healthy for Jinny and her actions were undermining my efforts to help her stop focusing on her weight. We came up with a solution: since she really needed to know her weight progress, I would meet with her once a month to review her progress. Yes, I would share her weight with her, but she had to accept that it would only happen once a month and not at her daughter’s appointment.” (pp. 84-85)

Of course any parent who has watched their child starve themselves nearly to death is going to be fixated on weight. Each pound gained represents another step away from the awful abyss their child has fallen into. The notion that such interest is unhealthy or somehow undermining treatment is both wrong-headed and deeply offensive. I hope this mom fired Carlton and found a smarter, more compassionate therapist who would actually empower the family to help Jinny recover.

Carlton insists that families need to find experienced eating disorders therapists and specialists to make up the treatment team for their child. In my family's experience, the “specialists” were frequently so heavily invested in their own particular take on eating disorders—-and often this was an outmoded and ineffective one—-that they were not able to give my daughter what she needed. A good therapist can be helpful. A bad therapist can do a lot of damage. And you don’t need collateral damage when you’re dealing with an eating disorder.

Finally, Carlton seems to subscribe to the notion that eating disorders are caused at least in part by psychology: “Without appropriate psychiatric help and treatment, eating disorders can become lifelong illnesses. To regain a healthy relationship with her body and with food, your daughter may require long-term treatment, which may continue long after her body is considered medically healed. The average length of psychological treatment is two to three years.” (p. 88)

Actually studies on family-based treatment (the Maudsley approach) show that teens often recover without this kind of intensive psychological or psychiatric treatment, and the recovery "takes": 90 percent are still recovered five years later. Carlton’s perspective gives families the wrong message: that only the doctor can “take charge” of their child’s eating disorder and bring about recovery.

In my experience, and in the experiences of many families I know, the reverse is true: recovery happened when parents were empowered to "take charge" of their child's recovery, often with backing from a truly supportive team.

The best part of this book is the insurance section. Too bad Carlton didn't publish just that. Except for that one chapter, you’re better off reading Help Your Teenager Beat an Eating Disorder by James Lock and Daniel Le Grange or Eating With Your Anorexic by Laura Collins.

Is anorexia like alcoholism?

The first question people ask after they read our family's story of helping our daughter Kitty recovery from anorexia: Is this like alcoholism, where she'll be dealing with it for the rest of her life?

It's a fair question, given the fact that traditional rates of relapse in anorexia are extraordinarily high--up to 50% of anorexia sufferers relapse within a year of treatment, according to one 2001 study. I know of several girls my daughter's age who are in the midst of relapses right now. My heart goes out to them.

The first few times people asked this question, it made me cry. The thought that my daughter might have to deal with anorexic thoughts, feelings, and behaviors for the rest of her life is awful and scary and beyond demoralizing.

But there's good reason to hope that for girls like Kitty, whose anorexia is treated relatively quickly (within 3 years of onset) and who become fully weight restored (not to 90 percent of their ideal body weight, as many clinicians are willing to settle for, but to 100 or 110 percent), relapse is far less likely. Preliminary studies of long-term outcomes for teens treated with the Maudsley approach, or family-based therapy, are very promising.

So now when people ask the question, I answer this way: We don't know what will happen for Kitty in the future. But we're hopeful that 10 years from now she will look back on anorexia as one of the trials of adolescence, not as a defining moment in her life. She'll remember it (actually I hope she doesn't remember many of the really bad moments) rather than still be experiencing it.

Our job will be to watch and protect her for the rest of her adolescence, especially when she goes to college, which is often a vulnerable time. Which, when you think of it, is what a parent's job is all about, anyway--to protect and take care of a child.

The rest of the family

An incident that happened at my sixth-grader's school last fall prompted me to write a piece about the effects of eating disorders on the rest of the family, which appeared in yesterday's New York Times. (Sorry, I can't do links when I'm blogging remotely, and right now I'm sitting at the airport waiting for a flight that's been delayed 6 hours.) The URL is http://www.nytimes.com/2007/03/06/health/06case.html?em&ex=1173416400&en=774d3d641fa1234b&ei=5087%0A.

But truly, this kind of fallout is true whenever one child in a family is desperately ill, particularly if the illness has a chronic or potentially lethal component. Having a sibling with cancer, diabetes, autism, developmental delays, and other conditions always creates a difficult situation for the other sibling.

I was an other sibling when I was growing up. Today, no doubt, our family would have wound up in family therapy, but back then my sister was the one who got the diagnosis "emotionally troubled," whatever that was supposed to mean. I now understand that she was most visibly acting out many of the feelings swirling around our little family. Even so, her behaviors and condition dominated the household.

I remember what it was like to have to stuff my feelings so as not to upset the teetering balance of our family dynamic; to resent the attention she got even though it was mostly negative attention, and clearly she was miserable; to wish that her problems, whatever they were, would just go away. This perspective was much on my mind last year and now as I watch my younger daughter struggle with the fallout from her sister's illness.

I have enormous respect for both my daughters, for the pain and difficulties they have both suffered, as well as for all children living with chronic illnesses, whatever they are. And I'm grateful that we now understand a lot more about how illnesses like these change the family, and what to do about it: Get the best medical care possible and then love the heck out of our children, and ourselves.

Maybe that's not so different from what our parents did.

Another Lead Fork award goes to . . .

the well-meaning but clueless youth director who recently sent home a flyer to parents in her church describing an upcoming activity for middle-schoolers titled "Hunger Feast!" This activity, which was described as "strongly encouraged," involves middle schoolers going without food for 30 hours in a lock-in at the church to "raise our awareness of hunger in the world and in our midst." The flyer goes on:

"Many of the activities we do during the lock-in focus on food (preparing food for and sharing it with others, doing volunteer tasks in the pantry, etc.); so we feel the ache of knowing that food is available to some, but—for this brief period of time—not to us. Experiences like this deepen our understanding of and increase empathy for the real human suffering that underlies the statistics.

There is, however, another aspect to this time of fasting. Fasting is a spiritual discipline, defined as “the voluntary abstention from an otherwise normal function—most often eating—for the sake of intense spiritual activity”. In addition to our hunger awareness activities, we also experience worship and prayer. It is always touching to observe the tender reactions of youth when they experience worship after having gone without food for a whole day. It is a powerful experience."

My recommendation: If you want your middle schoolers to develop empathy for those who are hungry, educate them--and yourself--about eating disorders. Celebrate food as part of life--a holy part of life, if you will--and have your kids volunteer at a food bank or soup kitchen. But for god's sake--and theirs--don't make self-starving holy or exalted.

National Eating Disorders Awareness Week

Today marks the start of National Eating Disorders Awareness Week, and our family marked the day by taking part in the Virtual Family Dinner sponsored by Maudsley Parents. We sat down to dinner at a friend's house and ate chicken curry, salad, and homemade pumpkin chocolate chip muffins.

The food was delicious. Even more delicious was the fact that we all ate, together, and ED was not at our table. Not tonight, anyway, and hardly at all for the last nine months.

Two years ago we were still ignorant about our daughter's anorexia. A year ago we were in the midst of Maudsley treatment. Tonight we ate with the memories of anorexia fresh but beginning to fade, and the hope that next year we will be that much further away from the nightmare.

My deepest wish for all of you, all of us, is that in the years to come we banish ED from all of our dinner tables. That we learn to feed ourselves and one another with joy and love and appreciation for what tastes good as well as for our selves, body and soul and mind and heart.

Jane Brody on binge eating disorder

Jane Brody wrote a personal and very powerful column in yesterday's New York Times about her own experience with binge eating disorder. It's worth reading, whether you've had experience with BED or another eating disorder or not, for its description of the slow, inexorable descent into hell that eating disorders entail.

Defintely worth a read.

Anorexia as metaphor

Recently I've read seveal memoirs about being anorexic, or books by doctors about eating disorders, that emphasize the metaphoric context of anorexia and bulimia. They talk about anorexics craving emptiness and hunger, the politics of appetite, the power trip of self-starvation.

I can see that for those who suffer from anorexia for a long time--more than a year? more than two?--the natural human tendency to assign meaning and metaphor to biological reality kicks in. When you live with something for a long time, it becomes part of your self-image, a key element in how you see yourself.

Such writers tend to make an important and to my mind unsupported leap, though. They generalize backward from their own situation, years down the line with anorexia, and conclude that the metaphor is what causes girls and boys to become anorexicv. This is the classic pitfall in anorexia treatment, the conventional wisdom espoused by doctors and therapists. And it's wrong.

It's important for parents and therapists and doctors to not get sucked in to the persuasive world of the anorexia metaphor. To remember that the vast majority of anorecxics become sick accidentally, from a diet that takes on a life of its own, an illness, a natural propensity for losing weight that gets pushed too far in some way and takes over a child's physial and psychological life.

To buy in to the notion of anorexia as metaphor is, frankly, to fall under its sway. I think this is one reason why, as Daniel Le Grange told me, even doctors and therapists sometimes make bad decisions about anorexia. "It's as if the anorexia affects the thinking processes of those around the sufferer," he told me.

I think the mechanism he was talking about is metaphor. And that's why I think it's absolutely vital that we de-metaphorize anorexia. We can best help our children--and other people's children--by taking anorexia's power away, both literally and metaphorically. By remembering that anorexia is a biological disease and that its symptoms and consequences are larely the result of starvation. And that the first line of treatment for it is not psychological but physiological: food.

There is time later, after a child is weight restored and mentally restored, to discuss the metaphors of eating disorders, if they apply. But it's a dangerous trap to fall into that conversation right away.

Why do we settle for treatment that doesn't work?

This morning I'm feeling so grateful for the Maudsley approach of treating anorexia, which I am sure saved my daughter's life. While there may be a better treatment out there yet to be discovered someday, for now Maudsley is so much better for teens than traditional treatment that it's hard for me to understand how and why professionals could recommend anything else.

Especially pediatricians. They're the ones on the front lines. They're the ones who presumably know a child, watch his or her growth from infancy on. Who have a chance to see the growth curve and know when a child is "just thin" or "too thin." When thinness becomes pathological.

Often pediatricians wait far too long to flag a problem--very likely because they're watching for the opposite problem, overweight in teens. Our society has such a strong fat phobia that all of us, myself included, have to struggle to take off our "thin-is-always-good" glasses and see reality sometimes.

Some pediatricians will notice a drop in weight or off the child's growth curve, but then stall when it comes to treatment, letting months or even years go by while a child starves and anorexia becomes more entrenched. Why? Could it be that many pediatricians--especially women--have eating or body or weight issues themselves?

If your intuition tells you that your child might have a problem, get another opinion. Follow your gut. The treatment you pursue might save your child's life. And you don't have to settle for treatment that doesn't work. There is hope for anorexia. The vast majority of teens treated with the Maudsley approach are weight restored, fully recovered, and back to normal life--and stay that way five years down the line.

Don't settle for anything less than your child's best life.

If you've ever loved a Mr. Wrong . . .

I'm looking for a few brave readers to read MR. WRONG: REAL-LIFE STORIES ABOUT THE MEN WE USED TO LOVE and write a review for amazon.com. I'm going to NY this week (tomorrow, actually) to promote the book and a couple of reviews on amazon would help. And of course, I hope you like it and write a good review, but hey, you should tell the truth.

If you're up for a little book reviewing, click here.

Happy reading!

Ranking eating disorders

Last week a study published in the journal Biological Psychiatry (love the name! um, what other kind of psychiatry is there?) made the headlines by proclaiming that the most prevalent eating disorder in the U.S. is binge eating disorder. It said that 3.5% of women have episodes of "uncontrollable eating" at least twice a week for at least three months at a time. In classic sensationalist style, BED is now bring described as the "biggest" eating disorder in the U.S.

I had binge eating disorder for much of my teens, 20s, and 30s. It didn't have a name then, or at least I was unaware of it. It didn't seem unusual to me; other women in my familiy clearly had it too. It wasn't a good thing, and I wanted to change my eating patterns. I saw various therapists and finally landed with a good one in my late 30s. I signed up for 10 weeks of eating sessions and wound up with 8 years of intensive, fantastic therapy. Somewhere along the way I stopped eating compulsively, and while I still overeat on occasion, I have a healthier relationship with food now.

I hardly noticed when I "recovered" from compulsive eating. My weight dropped a whopping pounds. That's about it.

Why am I telling you all this? Because I'm worried that the hoo-ha over binge eating disorder will add fat (excuse the pun) to the anti-obesity fire. And that's bad news for all of us, whether we're fat, "normal," or suffer from anorexia or bulimia.

I don't want to play the "which is worse?" game. But as someone with personal experience of both B.E.D. and anorexia, I have to say there's no comparison. B.E.D. isn't a good thing, but it doesn't disrupt your life. Anorexia, the most deadly psychiatric disorder, kills. And while some people maintain a facsimile of ordinary life while they're anorexic, most do not.

I'm not saying it's OK to have an eating disorder. But I worry when I see all e.d.s lumped into the same category and discussed in the same terms. It simply isn't true. Anorexia is a life-and-death diagnosis. B.E.D. is not.

More anti-obesity rhetoric won't cause the prevalence of anorexia to rise, but it might trigger more people who are susceptible into active restricting and anorexia. And it certainly contributes to the culture of thinness that reflects our overall disordered relationship with food and eating.

It can and does affect treatment protocols, too. In my experiences (and the experiences of many families I've talked to), I've seen how the culture and bias toward thinness extends into the medical profession--sometimes quite deeply. One of the dirty little secrets well known among families with anorexic children is that doctors consistently set target weights that are far too low for true recovery. Not surprising, when you consider that a third of all eating disorders specialists have suffered (or still suffer) from an eating disorder themselves.

So my fear is that all this uproar over B.E.D., and how it's the "biggest" e.d., will cause more grief for families who are struggling with the ravages of anorexia.