This morning's program featured two parents and a husband, all of whom had family members who had anorexia, all of whom had the same therapist. I have tremendous respect for all three of these people, who obviously went through tremendous suffering. I'm happy to say that all three of their family members recovered and are now doing well--but only after many years of being ill. One spouse was ill for 10 years; one of the children was sick for 6 or 7 years, and the other for 10 years.
One of the parents made a comment that for me crystallized everything that's wrong with the way eating disorders have been traditionally treated. He said, speaking of his then-11-year-old daughter, "My wife and I quickly had to accept the fact that this thing was bigger than we were, bigger than our family. There was no way we could help her. We had to turn to the professionals."
His child's recovery followed a fairly typical trajectory: years of very slow progress and relapse, until, as he put it, "She *decided to join us in the fight against her illness."
I got tears in my eyes at that moment, tears of rage for the clinicians who disempowered this family and made them believe there was *no way* they could help their daughter, who taught them that their daughter had to "choose" to get well. For all the families who have accepted that over the years, who have sat at dinner tables watching their children starve and felt there was nothing they could do. Who, frankly, wasted years of their own and their child's life in useless and even counterproductive treatment.
I am so grateful for family-based treatment, for having my role as a parent validated and for being able to help my daughter. Another of the parents said, "I wanted to just march in there and get this thing fixed! But we had to embrace the illness and accept that it would be with us for a long, long time."
If only she'd been told about FBT, how might her life and the life of her daughter have been different?
Saturday, October 06, 2007
Friday, October 05, 2007
If only they knew . . .
Over the last two days I've collected quite a bit of material from the many residential treatment centers that are exhibiting here at NEDA. I'm going to be writing about a few of them, starting with the brochure from Rogers Memorial Hospital in Oconomowoc.
If only the people who'd put this slick piece of marketing together knew how parents really reacted to it--or should. I already have an opinion about the programs at Rogers, but if I didn't, this would certainly sway me.
For starters, the image on the cover is of a girl. A young woman, really, maybe 14 or 15 years old. She's smiling, she's very pretty--and she's excruciatingly thin. It's hard to tell just how thin because she's wearing a hoodie over a shirt. But she's a lot thinner than I'd want any child of mine to be. Is she supposed to be recovered? In recovery? Newly arrived at Rogers? If this is a picture of the Rogers recovery, I'd run in the opposite direction. Fast.
Then there are the words that go with this image: "At Rogers Memorial, we utilize proven, evidence-based treatment components that give individuals with an eating disorder the best chance at recovery."
So far, so good. But there's more: "Our philosophy encourages self-empowerment, so that the individual's recoveryt is a result of his or her own success."
Uh-oh. If I'm a new parent I might think this sounds good. But everyone else will read this and know what it refers to: the tired, disproven notion that the individual must "choose" recovery.
Next come some quotes, presumably from Rogers patients, though they're not identified. Top of the list: "The treatment and therapies helped me realize it was my choice to get better." I say stop reading right there and throw the darn thing away. But if you insist on continuing, you'll find this one: "The art therapy was extremely helpful and provided another way for me to explore my eating disorder."
Explore your eating disorder? Honey, I don't want you to explore your eating disorder. I want you to RECOVER from it. Big difference. In fact we may be talking an oxymoron here.
Seen enough? No? Then turn the page for more on the Rogers approach: "Our treatment approach encourages self-empowerment. From admission to discharge and aftercare planning, individuals are involved in every step of the treatment process."
As the parent of a child who's recovered from an e.d., I can't think of anything worse than to have my child involved at every step of the way. As those of us who have been through this know, a child is INCAPABLE of "choosing" recovery, and when she's very very ill, such insistence will a) prolong the course of the disease, b) make treatment ineffective, c) exacerbate the child's already sky-high anxiety, and d) make veryone involved feel guilty as hell for not being able to "choose" recovery.
And here's the thing that gets me: This brochure is supposed to be marketing the program, making it sound irresistible to parents.
I'd say the Rogers folks haven't got a clue about what at least some parents want. And judging from this brochure, I'd say my confidence in their ability to help my child recover is pretty minimal.
That's it for tonight. I'll pick apart some more tomorrow.
If only the people who'd put this slick piece of marketing together knew how parents really reacted to it--or should. I already have an opinion about the programs at Rogers, but if I didn't, this would certainly sway me.
For starters, the image on the cover is of a girl. A young woman, really, maybe 14 or 15 years old. She's smiling, she's very pretty--and she's excruciatingly thin. It's hard to tell just how thin because she's wearing a hoodie over a shirt. But she's a lot thinner than I'd want any child of mine to be. Is she supposed to be recovered? In recovery? Newly arrived at Rogers? If this is a picture of the Rogers recovery, I'd run in the opposite direction. Fast.
Then there are the words that go with this image: "At Rogers Memorial, we utilize proven, evidence-based treatment components that give individuals with an eating disorder the best chance at recovery."
So far, so good. But there's more: "Our philosophy encourages self-empowerment, so that the individual's recoveryt is a result of his or her own success."
Uh-oh. If I'm a new parent I might think this sounds good. But everyone else will read this and know what it refers to: the tired, disproven notion that the individual must "choose" recovery.
Next come some quotes, presumably from Rogers patients, though they're not identified. Top of the list: "The treatment and therapies helped me realize it was my choice to get better." I say stop reading right there and throw the darn thing away. But if you insist on continuing, you'll find this one: "The art therapy was extremely helpful and provided another way for me to explore my eating disorder."
Explore your eating disorder? Honey, I don't want you to explore your eating disorder. I want you to RECOVER from it. Big difference. In fact we may be talking an oxymoron here.
Seen enough? No? Then turn the page for more on the Rogers approach: "Our treatment approach encourages self-empowerment. From admission to discharge and aftercare planning, individuals are involved in every step of the treatment process."
As the parent of a child who's recovered from an e.d., I can't think of anything worse than to have my child involved at every step of the way. As those of us who have been through this know, a child is INCAPABLE of "choosing" recovery, and when she's very very ill, such insistence will a) prolong the course of the disease, b) make treatment ineffective, c) exacerbate the child's already sky-high anxiety, and d) make veryone involved feel guilty as hell for not being able to "choose" recovery.
And here's the thing that gets me: This brochure is supposed to be marketing the program, making it sound irresistible to parents.
I'd say the Rogers folks haven't got a clue about what at least some parents want. And judging from this brochure, I'd say my confidence in their ability to help my child recover is pretty minimal.
That's it for tonight. I'll pick apart some more tomorrow.
More from NEDA
One of the heartening things about the conference so far has been that the amount and kind of discussion around family-based (Maudsley) treatment for anorexia and bulimia. There's been a lot! And all of it's been positive, at least that I've heard. In fact I would say that Maudsley has become something of a buzzword. Some of the people using it seem to have only a hazy idea of what it means, but I guess that's part of the process of this kind of social change.
The general session speakers have been a real mixed bag. This morning's speaker spent more time telling anecdotes about her cats, her children, and herself than anything else, and when she did finally get down to brass tacks, she mostly talked about body image. I'm all for discussions of body image, and how to improve it, but what got to me was her automatic assumptions that disturbances of body image = eating disorders. There was a lot of talk about things like guided visualizations, talking "to" problem body parts, and so on, none of which interests me but hey, I can see that it might be of interest to some people.
The thing that got me, though, was when she tried to connect these kinds of problems and solutions to anorexia. I asked her, if body image disturbance causes e.d.s, why don't we have way more prevalence of anorexia and bulimia? She had no answer. Later, someone else suggested to me that while AN and BN are relatively low incidence, there are a lot of eating disorder not specified cases that don't show up in the statistics. Maybe. What bugs me is the thought of people with anorexia and bulimia who are valiantly trying to recover through these kinds of treatment techniques. There is no evidence to suggest that they're effective. Common sense, and having gone through anorexia with my daughter, tells me they can be worse than useless--they can destructive because they take focus off the things that really matter, like refeeding. So I'm not thrilled with what I heard there.
This afternoon's speaker, Michael Strober, did a very good job of discussion some of the neurobiology of comorbidities. He made one interesting point (well, he made more, but this one was of most interest to me): he said that while most depression that you see in patients with anorexia comes as a result of the starvation, and shows up after and as a byproduct of malnutrition, the heightened anxiety you see almost always precedes the dieting and weight loss behaviors. This was certainly the case in our family: my first inkling that anything was wrong with my daughter was her anxiety level skyrocketed, and she'd never been an anxious kid. No one understands the mechanism, but it was a very interesting observation.
That's it for now--gotta go get in the hot tub! (LOL)
More from San Diego later.
The general session speakers have been a real mixed bag. This morning's speaker spent more time telling anecdotes about her cats, her children, and herself than anything else, and when she did finally get down to brass tacks, she mostly talked about body image. I'm all for discussions of body image, and how to improve it, but what got to me was her automatic assumptions that disturbances of body image = eating disorders. There was a lot of talk about things like guided visualizations, talking "to" problem body parts, and so on, none of which interests me but hey, I can see that it might be of interest to some people.
The thing that got me, though, was when she tried to connect these kinds of problems and solutions to anorexia. I asked her, if body image disturbance causes e.d.s, why don't we have way more prevalence of anorexia and bulimia? She had no answer. Later, someone else suggested to me that while AN and BN are relatively low incidence, there are a lot of eating disorder not specified cases that don't show up in the statistics. Maybe. What bugs me is the thought of people with anorexia and bulimia who are valiantly trying to recover through these kinds of treatment techniques. There is no evidence to suggest that they're effective. Common sense, and having gone through anorexia with my daughter, tells me they can be worse than useless--they can destructive because they take focus off the things that really matter, like refeeding. So I'm not thrilled with what I heard there.
This afternoon's speaker, Michael Strober, did a very good job of discussion some of the neurobiology of comorbidities. He made one interesting point (well, he made more, but this one was of most interest to me): he said that while most depression that you see in patients with anorexia comes as a result of the starvation, and shows up after and as a byproduct of malnutrition, the heightened anxiety you see almost always precedes the dieting and weight loss behaviors. This was certainly the case in our family: my first inkling that anything was wrong with my daughter was her anxiety level skyrocketed, and she'd never been an anxious kid. No one understands the mechanism, but it was a very interesting observation.
That's it for now--gotta go get in the hot tub! (LOL)
More from San Diego later.
San Diego dispatch
Here I am in beautiful San Diego at the NEDA conference. It's my first time at something like this and I'm not sure what to expect. So far . . . well, it's a mixed bag.
Yesterday afternoon I was lucky enough to have lunch on the UC-San Diego campus with Dr. Walter Kaye and his talented team. Their 5-day Intensive family outpatient program for treating anorexia and bulimia sounds fab to me. (Check it out at http://eatingdisorders.ucsd.edu/IFT.html.) If the program had been around when my daughter was diagnosed with anorexia, I think we would have been here in a heartbeat. And I think it would have been a life saver. Literally.
Back at NEDA, pretty much the first thing I did was wander the hall of goodies, where the folks who treat e.d.s set up booths and put out their marketing info. It was all very slick and very disheartening. I walked around asking people what their treatment philosophy was. Half of them didn't understand the question. Many reassured me that they had "all kinds of treatments." Horses seemed to figure prominently, at least in the literature, along with "groups getting at the psychosocial dynamics of anorexia" and so on. When I asked what kind of evidence-based treatments they offered, most looked blank. When I asked how or whether they included families in treatment, a few sounded intelligent, but most, once more, looked blank.
Then again, we're dealing with an area where the American Psychological Association itself still lists
"dysfunctional families or relationships" as one cause of anorexia, and describes the anorexics as "refusing to eat." Tsk tsk, APA; you're sadly out of date. If you knew one thing about anorexia you would know that it's not a refusal to eat; it's an inability to. And you'd also know that PARENTS DO NOT CAUSE EATING DISORDERS. (Read the APA's ill-informed e.d. page at http://www.apahelpcenter.org/articles/article.php?id=9.)
The worst of the hall were the booths sponsoed by the big guns in e.d. treatment: Renfrew, Rader, Remuda. There were lots of slick little products to take home, ranging from staplers to, I kid you not, Zen sand gardens. What does all this have to do with treatment? You have to be cynical here and remember that there's very big money attached to the treatment of e.d.s. I would have far preferred an outcome study for parents to take away over a cutesy little mirror with an affirmation on the back. Please.
The keynote speech last night started out well, with a report from Lynn Grefe, the president of NEDA. Next up was a young editor from CosmoGirl whose main purpose seemed to be to convince us of how well-meaning that magazine is about presenting positive body images to young women. It sounded like one big advertisement for CosmoGirl. Somewhere in there she referred earnestly to an article they'd run called "Fat and Thin," and flashed a visual from the magazine on the screen. There it was: a headless fattie, next to a headless waif, followed by more earnest talk about how obesity is an eating disorder, too.
I wanted to stand up and say, "That's like saying thinness is an eating disorder, honey. It's not how much you weigh; it's your relationship with food and eating." But it is, after all, my first NEDA conference, and I was feeling a little shy.
Next time.
More from NEDA later today.
Yesterday afternoon I was lucky enough to have lunch on the UC-San Diego campus with Dr. Walter Kaye and his talented team. Their 5-day Intensive family outpatient program for treating anorexia and bulimia sounds fab to me. (Check it out at http://eatingdisorders.ucsd.edu/IFT.html.) If the program had been around when my daughter was diagnosed with anorexia, I think we would have been here in a heartbeat. And I think it would have been a life saver. Literally.
Back at NEDA, pretty much the first thing I did was wander the hall of goodies, where the folks who treat e.d.s set up booths and put out their marketing info. It was all very slick and very disheartening. I walked around asking people what their treatment philosophy was. Half of them didn't understand the question. Many reassured me that they had "all kinds of treatments." Horses seemed to figure prominently, at least in the literature, along with "groups getting at the psychosocial dynamics of anorexia" and so on. When I asked what kind of evidence-based treatments they offered, most looked blank. When I asked how or whether they included families in treatment, a few sounded intelligent, but most, once more, looked blank.
Then again, we're dealing with an area where the American Psychological Association itself still lists
"dysfunctional families or relationships" as one cause of anorexia, and describes the anorexics as "refusing to eat." Tsk tsk, APA; you're sadly out of date. If you knew one thing about anorexia you would know that it's not a refusal to eat; it's an inability to. And you'd also know that PARENTS DO NOT CAUSE EATING DISORDERS. (Read the APA's ill-informed e.d. page at http://www.apahelpcenter.org/articles/article.php?id=9.)
The worst of the hall were the booths sponsoed by the big guns in e.d. treatment: Renfrew, Rader, Remuda. There were lots of slick little products to take home, ranging from staplers to, I kid you not, Zen sand gardens. What does all this have to do with treatment? You have to be cynical here and remember that there's very big money attached to the treatment of e.d.s. I would have far preferred an outcome study for parents to take away over a cutesy little mirror with an affirmation on the back. Please.
The keynote speech last night started out well, with a report from Lynn Grefe, the president of NEDA. Next up was a young editor from CosmoGirl whose main purpose seemed to be to convince us of how well-meaning that magazine is about presenting positive body images to young women. It sounded like one big advertisement for CosmoGirl. Somewhere in there she referred earnestly to an article they'd run called "Fat and Thin," and flashed a visual from the magazine on the screen. There it was: a headless fattie, next to a headless waif, followed by more earnest talk about how obesity is an eating disorder, too.
I wanted to stand up and say, "That's like saying thinness is an eating disorder, honey. It's not how much you weigh; it's your relationship with food and eating." But it is, after all, my first NEDA conference, and I was feeling a little shy.
Next time.
More from NEDA later today.
Monday, October 01, 2007
Are you going to NEDA?
To the annual National Eating Disorders Association conference in San Diego, that is. If so, please look me up and say hello. I'll be presenting on Friday afternoon, along with Dr. Walter Kaye and Laura Collins, author of Eating With Your Anorexic. Stellar company and what promises to be a much-needed panel discussion on families and eating disorders treatment.
Tuesday, September 25, 2007
Finally, we're talking about eating (rather than weight)
Amid the usual hysterical news stories about the so-called obesity epidemic I was pleased to come across an item about new research out of Penn State looking at eating competence as a risk factor in heart disease.
Using an eating competence scale developed by Ellyn Satter, researchers found that--surprise, surprise--people at risk for heart disease fared better when they were "confident, comfortable, and flexible with their eating habits."
Being comfortable with your eating seems to mitigate other risk factors, including elevated LDL cholesterol. It's process over product, holistic health over health-by-the-numbers. It's the act of eating rather than the rigidly controlled carbs and calories approach.
Now we know the truth: fear of food is bad for your health. Mangia va bene!
Using an eating competence scale developed by Ellyn Satter, researchers found that--surprise, surprise--people at risk for heart disease fared better when they were "confident, comfortable, and flexible with their eating habits."
Being comfortable with your eating seems to mitigate other risk factors, including elevated LDL cholesterol. It's process over product, holistic health over health-by-the-numbers. It's the act of eating rather than the rigidly controlled carbs and calories approach.
Now we know the truth: fear of food is bad for your health. Mangia va bene!
Tuesday, September 18, 2007
Eating Disorders Coalition action alert
Anyone who's ever tried to get a mental health issue covered by insurance (or, as they're called in our state, "behavioral health issues") will want to act on the EDC's latest action alert:
"You can help Pass the Paul Wellstone Mental Health and Addiction Equity Act (H.R. 1424) today by calling House Speaker Nancy Pelosi toll-free at 877.978.9996 and telling her that you support the passage of this mental health parity act."
"You can help Pass the Paul Wellstone Mental Health and Addiction Equity Act (H.R. 1424) today by calling House Speaker Nancy Pelosi toll-free at 877.978.9996 and telling her that you support the passage of this mental health parity act."
Thursday, September 13, 2007
The sound of one shoe dropping
The other shoe, that is. It's been a hell of a few years in our household, between medical traumas of various kinds, including Kitty's anorexia, my mother-in-law's lingering illness and death, and now the legal machinations of her despicable and greedy second husband. (Who knew people could be such asshats?)
So now I'm down with some health problems of my own, hopefully not for too long and nothing permanent, but very unpleasant in the short term.
So forgive me if I don't do too much posting for a little while. Carry on.
So now I'm down with some health problems of my own, hopefully not for too long and nothing permanent, but very unpleasant in the short term.
So forgive me if I don't do too much posting for a little while. Carry on.
Tuesday, September 11, 2007
Today's post is a poem
It's true: I cop to being a poet first and foremost.
SEPTEMBER 11, 2001: POEM FOR MY LATE FORTIES
See, one day I realized I was thinking about death
as if it were a problem I could solve, as if
through sheer brilliance, hard work, or luck
I could outwit my fate, land safe on solid ground.
So all of this, I mused—-the sweet blue sky,
the falling light, the dizzy bone-deep fix
of oxygen and sun and fire—-was plain
out of my hands. I was free, it seemed,
to keep on stumbling—-blind, confused,
ticked off—-up the old twisting path,
to reach the top at last and claim
my prize: to face the dark wood,
as the poet said, and, pissing
in my pants with fear, go on.
To be published in Oberon later this year
SEPTEMBER 11, 2001: POEM FOR MY LATE FORTIES
See, one day I realized I was thinking about death
as if it were a problem I could solve, as if
through sheer brilliance, hard work, or luck
I could outwit my fate, land safe on solid ground.
So all of this, I mused—-the sweet blue sky,
the falling light, the dizzy bone-deep fix
of oxygen and sun and fire—-was plain
out of my hands. I was free, it seemed,
to keep on stumbling—-blind, confused,
ticked off—-up the old twisting path,
to reach the top at last and claim
my prize: to face the dark wood,
as the poet said, and, pissing
in my pants with fear, go on.
To be published in Oberon later this year
Saturday, September 08, 2007
Entering the dieting/FA fray
I'm going to tell you a story: I once had a friend named Mimi Orner who was a fat activist, woman of size, brilliant teacher, and all-around wonderful person. Here in Madison, Wis., where I live, she started a group that was anti-anorexia, anti-bulimia, and anti-dieting. This was about 15 years ago, mind, somewhat ahead of her time.
Mimi died seven years ago from ovarian cancer. Her appetite for food, like her appetite for life, lasted until pretty close to the very end. Her memorial service was attended by hundreds of people, many of whom got up to speak. All of these tributes were very moving, but the one I remember was a young woman who stood up, tears pouring down her face, and confessed that she and Mimi had once been close but of late had been a little bit estranged. "I found her so inspiring," she said through tears, "and I want to believe what she ways [about fat acceptance]. I'm not as smart or as good as Mimi. I just can't accept myself as a fat person, at least not yet. So we grew apart. And I've missed her so much. And now I'll never have the chance to make it right."
This young woman's words have stayed with me because they capture so vividly the dilemma of the individual and the political. Sometimes, you know, the emotions take a while to catch up with the intellect. Sometimes they never do. That's part of being human. We can't legislate our feelings.
Much as we might like to sometimes.
I miss Mimi too. I wished she was there two years ago when my daughter got sick. I wished she was there when I gained 50 pounds from a medication and struggled with that. I wish she were here now, so we could debate and argue and disagree and learn from each other.
Mimi died seven years ago from ovarian cancer. Her appetite for food, like her appetite for life, lasted until pretty close to the very end. Her memorial service was attended by hundreds of people, many of whom got up to speak. All of these tributes were very moving, but the one I remember was a young woman who stood up, tears pouring down her face, and confessed that she and Mimi had once been close but of late had been a little bit estranged. "I found her so inspiring," she said through tears, "and I want to believe what she ways [about fat acceptance]. I'm not as smart or as good as Mimi. I just can't accept myself as a fat person, at least not yet. So we grew apart. And I've missed her so much. And now I'll never have the chance to make it right."
This young woman's words have stayed with me because they capture so vividly the dilemma of the individual and the political. Sometimes, you know, the emotions take a while to catch up with the intellect. Sometimes they never do. That's part of being human. We can't legislate our feelings.
Much as we might like to sometimes.
I miss Mimi too. I wished she was there two years ago when my daughter got sick. I wished she was there when I gained 50 pounds from a medication and struggled with that. I wish she were here now, so we could debate and argue and disagree and learn from each other.
Tuesday, September 04, 2007
Ass-backward science
I used to think the Brits were far more evolved than we Yanks. But that was before Marcella sent me this unbelievable bit of rationalizing from the U.K Food Standards Agency.
According to guidelines passed by the FSA, cheese, honey, marmite (that's how you know you're in the UK), and breast milk* are unhealthy and therefore banned as the subjects of food advertising to kids.
On the other hand, chicken nuggets, microwaveable curries, oven chips (I assume this is french fries), and diet sodas are A-OK, according to these standards.
This is what I think of as ass-backward science: First you decide what result you want your data to show. Then you screw with said data until it shows it.
So the makers of chicken nuggets can happily continue to flog their stuff to the kiddies**, but the beekeepers and cheese makers are SOL.
Nice going, guys.
* Breast milk's fat content would render it unhealthy by the FSA's standards.
** I lived in London for a year and I speak Brit too!
According to guidelines passed by the FSA, cheese, honey, marmite (that's how you know you're in the UK), and breast milk* are unhealthy and therefore banned as the subjects of food advertising to kids.
On the other hand, chicken nuggets, microwaveable curries, oven chips (I assume this is french fries), and diet sodas are A-OK, according to these standards.
This is what I think of as ass-backward science: First you decide what result you want your data to show. Then you screw with said data until it shows it.
So the makers of chicken nuggets can happily continue to flog their stuff to the kiddies**, but the beekeepers and cheese makers are SOL.
Nice going, guys.
* Breast milk's fat content would render it unhealthy by the FSA's standards.
** I lived in London for a year and I speak Brit too!
A basic misunderstanding of anorexia
has got to be part of where nutrition "expert" Dr. Elliott Berry is coming from when he offered the latest in potential anorexia treatment: cannabis.
You can't blame Dr. Berry; anyone who reads DSM-IV gets the same wrong-headed criteria for anorexia front and center: Anorexia is a "refusal t maintain body weight at or above a minimally normal weight for age and height."
It's the word refusal that is so misleading. Those of us with personal knowledge understand that it should read inability to maintain body weight. Someone with anorexia isn't "refusing" to eat, because s/he's not really capable of making a choice on the subject of food and eating.
I'd love to see this definition change, and with it our notions of good treatment. I'd love to see a time when starvation would not be an option, when we didn't confuse appetite with illness. And I don't think cannabis has any place in the treatment of anorexia.
You can't blame Dr. Berry; anyone who reads DSM-IV gets the same wrong-headed criteria for anorexia front and center: Anorexia is a "refusal t maintain body weight at or above a minimally normal weight for age and height."
It's the word refusal that is so misleading. Those of us with personal knowledge understand that it should read inability to maintain body weight. Someone with anorexia isn't "refusing" to eat, because s/he's not really capable of making a choice on the subject of food and eating.
I'd love to see this definition change, and with it our notions of good treatment. I'd love to see a time when starvation would not be an option, when we didn't confuse appetite with illness. And I don't think cannabis has any place in the treatment of anorexia.
Monday, September 03, 2007
What obesity is
At least according to endocrinologist Robert Lustig: “Obesity is not a disease or a behavior. It’s a phenotype (a trait or characteristic in a subset of the population), which is a manifestation of many things.”
Lustig was talking about why there will never be a "one-size-fits-all" weight-loss drug.
Now if only he'd gone a step further, and questioned the need for a pill to change a phenotype.
Lustig was talking about why there will never be a "one-size-fits-all" weight-loss drug.
Now if only he'd gone a step further, and questioned the need for a pill to change a phenotype.
Saturday, September 01, 2007
Why intuitive eating works
This just in from an article published in today's edition of the Journal of Physiology: ". . . during a reduction in energy stores or circulating nutrients, the brain initiates responses to restore and maintain energy and glucose homeostasis. In contrast, in times of nutrient abundance and excess energy storage, the brain promotes reduced food intake and increased energy expenditure."
In other words, deprivation makes your brain and body store fat. But having access to plenty of food can lead to eating less and moving around more.
This has always been my experience. When I give myself permission to eat what I'm truly hungry for--and stop eating when I'm satisfied--I eat less than when I go into deprivation mode.
It's interesting to know that there's neurobiology at work. The human body is a wonderful thing.
In other words, deprivation makes your brain and body store fat. But having access to plenty of food can lead to eating less and moving around more.
This has always been my experience. When I give myself permission to eat what I'm truly hungry for--and stop eating when I'm satisfied--I eat less than when I go into deprivation mode.
It's interesting to know that there's neurobiology at work. The human body is a wonderful thing.
Friday, August 31, 2007
F as in Fat, K as in Knee-Jerk
On our last morning in Utah I picked up a copy of the Salt Lake City Tribne and was appalled (but not shocked, alas) to read an editorial based on the Robert Wood Johnson Foundation report mentioned a few days ago. Its concluding paragraph:
If you're "F" as in fat, you'll be "D" as in dead.
Talk about scare tactics. . . .
I haven't done a search, but I wonder how many other newspapers picked this up and ran with it.
If you're "F" as in fat, you'll be "D" as in dead.
Talk about scare tactics. . . .
I haven't done a search, but I wonder how many other newspapers picked this up and ran with it.
Thursday, August 30, 2007
The good doctor
After reading fillyjonk's recent post over at Shapely Prose, and all the comments that followed, I realized it's time to say thanks to my wonderful internist.
So here's to you, Dr. Nancy Fuller, for being the kind of doctor who has never slapped the scarlet O on me. To you I am a patient, not an unacceptable number on the scale. I've brought all kinds of health issues to your office, from panic disorder to hot flashes to headaches, and never once have you said or implied that it's All Because I Need to Lose Some Weight.
Thank goodness you are not Dr. Sanjay Gupta, who writes in Time magazine, "Obesity, of course, means a higher risk of heart disease, diabetes, hospitalization and early death, so how come doctors are so lax about putting the scarlet O on the chart?"
How come indeed, Dr. Gupta?
Could it be that some doctors look beyond the numbers on the scale to a patient's true health? That they know all too well that putting a patient on a a diet through scare tactics will almost always backfire, winding up with the patient heavier than they already are? That shame is not a good motivator, and neither is fear?
Could it be that some doctors are not as egotistical as you, who seem to to believe that those who are fat don't really know it until it's pointed out by a doctor?
Could it be that some doctors have gone a little deeper into the subject, and know that fat does not always (or even usually) equal bad health? That fat can be fit and healthy, and thin can be unhealthy?
I far prefer my good doctor's approach. She takes time to talk with me, listen to me, guide me toward healthy choices in all ways. When I walk in the door she sees me, not just my measurements. And so I trust her.
And that's the basis of a healthy doctor-patient relationship.
So here's to you, Dr. Nancy Fuller, for being the kind of doctor who has never slapped the scarlet O on me. To you I am a patient, not an unacceptable number on the scale. I've brought all kinds of health issues to your office, from panic disorder to hot flashes to headaches, and never once have you said or implied that it's All Because I Need to Lose Some Weight.
Thank goodness you are not Dr. Sanjay Gupta, who writes in Time magazine, "Obesity, of course, means a higher risk of heart disease, diabetes, hospitalization and early death, so how come doctors are so lax about putting the scarlet O on the chart?"
How come indeed, Dr. Gupta?
Could it be that some doctors look beyond the numbers on the scale to a patient's true health? That they know all too well that putting a patient on a a diet through scare tactics will almost always backfire, winding up with the patient heavier than they already are? That shame is not a good motivator, and neither is fear?
Could it be that some doctors are not as egotistical as you, who seem to to believe that those who are fat don't really know it until it's pointed out by a doctor?
Could it be that some doctors have gone a little deeper into the subject, and know that fat does not always (or even usually) equal bad health? That fat can be fit and healthy, and thin can be unhealthy?
I far prefer my good doctor's approach. She takes time to talk with me, listen to me, guide me toward healthy choices in all ways. When I walk in the door she sees me, not just my measurements. And so I trust her.
And that's the basis of a healthy doctor-patient relationship.
Tuesday, August 28, 2007
Another missed opportunity
The Robert Wood Johnson Foundation has just come out with a report, "F as in Fat: How Obesity Policies Are Failing in America in 2007," in which it makes the same tired (and superficial) observations and beats the same dead horse some more. According to the report:
* Adult obesity rates rose in 31 states last year.
* Twenty-two states experienced an increase for the second year in a row; no states decreased.
* A new public opinion survey featured in the report finds 85 percent of Americans believe that obesity is an epidemic.
This last one made me laugh out loud. And this proves what, exactly? That most Americans will believe anything the media spoon-feeds them? Deep into George W. Bush's second term, we already knew that. But I digress.
* Rates of adult obesity now exceed 25 percent in 19 states, an increase from 14 states last year and 9 in 2005. In 1991, none of the states exceeded 20 percent.
Of course the report fails to mention the change in the BMI chart that created millions of new overweight and obese people overnight. Oops--I digress again.
* "There has been a breakthrough in terms of drawing attention to the obesity epidemic. Now, we need a breakthrough in terms of policies and results," said Jeff Levi, Ph.D., executive director of Trust for America's Health.
You got that right! You'd think that maybe this would be the moment to stop, take stock, and say, Wait a minute, maybe we're fucking up here. Could it be that we're actually making things worse by flailing around? But no. Levi went on to say, "Poor nutrition and physical inactivity are robbing America of our health and productivity."
Give me a break. He's just parroting the conventional lack of wisdom that says all fat people are couch potatoes eating junk food and watching TV.
The press release goes on to tout other "key findings":
* Twenty-two percent of American adults report that they do not engage in any physical activity.
But there's no context for this. Has this changed? I think people are more physically active now than they were 20 or 30 years ago. When my grandmother and mother were my age, they weren't out hiking the Utah mountains or dancing all night. They didn't go to the gym, jog, or play softball. And yet we're the ones who have the "obesity epidemic."
Once more, an opportunity for reflection and going beyond the conventional wisdom--sadly missed.
But the report does more than list problems. It proposed solutions. Solutions like this one, which tops the list:
* The federal government should develop and implement a National Strategy to Combat Obesity. This plan should involve every federal government agency, define clear roles and responsibilities for states and localities, and engage private industry and community groups.
I don't know whether to fall on the floor laughing or be truly frightened. And what about this:
* Federal, state, and local governments should work with private employers and insurers to ensure that every working American has access to a workplace wellness program.
I don't want a workplace wellness program, because what I know about them is that they're as much a joke as school wellness curricula. They exist to penalize workers who don't measure up to the approved guidelines, through surtaxes for those who are overweight, for instance. Unless they're paying for health club memberships for employees, and giving them an hour and a half lunch to go work out, I don't want to hear about it.
If RWJF has its way, our already eating-disordered culture would go beserk. Talk about obsession--they want to get the whole freaking government involved.
What a nightmare.
**Read the press release yourself at www.rwjf.org/newsroom/newsreleasesdetail.jsp?id=10512, which also has a link to the full tet of the report. Sorry I can't link it--still remote blogging.
* Adult obesity rates rose in 31 states last year.
* Twenty-two states experienced an increase for the second year in a row; no states decreased.
* A new public opinion survey featured in the report finds 85 percent of Americans believe that obesity is an epidemic.
This last one made me laugh out loud. And this proves what, exactly? That most Americans will believe anything the media spoon-feeds them? Deep into George W. Bush's second term, we already knew that. But I digress.
* Rates of adult obesity now exceed 25 percent in 19 states, an increase from 14 states last year and 9 in 2005. In 1991, none of the states exceeded 20 percent.
Of course the report fails to mention the change in the BMI chart that created millions of new overweight and obese people overnight. Oops--I digress again.
* "There has been a breakthrough in terms of drawing attention to the obesity epidemic. Now, we need a breakthrough in terms of policies and results," said Jeff Levi, Ph.D., executive director of Trust for America's Health.
You got that right! You'd think that maybe this would be the moment to stop, take stock, and say, Wait a minute, maybe we're fucking up here. Could it be that we're actually making things worse by flailing around? But no. Levi went on to say, "Poor nutrition and physical inactivity are robbing America of our health and productivity."
Give me a break. He's just parroting the conventional lack of wisdom that says all fat people are couch potatoes eating junk food and watching TV.
The press release goes on to tout other "key findings":
* Twenty-two percent of American adults report that they do not engage in any physical activity.
But there's no context for this. Has this changed? I think people are more physically active now than they were 20 or 30 years ago. When my grandmother and mother were my age, they weren't out hiking the Utah mountains or dancing all night. They didn't go to the gym, jog, or play softball. And yet we're the ones who have the "obesity epidemic."
Once more, an opportunity for reflection and going beyond the conventional wisdom--sadly missed.
But the report does more than list problems. It proposed solutions. Solutions like this one, which tops the list:
* The federal government should develop and implement a National Strategy to Combat Obesity. This plan should involve every federal government agency, define clear roles and responsibilities for states and localities, and engage private industry and community groups.
I don't know whether to fall on the floor laughing or be truly frightened. And what about this:
* Federal, state, and local governments should work with private employers and insurers to ensure that every working American has access to a workplace wellness program.
I don't want a workplace wellness program, because what I know about them is that they're as much a joke as school wellness curricula. They exist to penalize workers who don't measure up to the approved guidelines, through surtaxes for those who are overweight, for instance. Unless they're paying for health club memberships for employees, and giving them an hour and a half lunch to go work out, I don't want to hear about it.
If RWJF has its way, our already eating-disordered culture would go beserk. Talk about obsession--they want to get the whole freaking government involved.
What a nightmare.
**Read the press release yourself at www.rwjf.org/newsroom/newsreleasesdetail.jsp?id=10512, which also has a link to the full tet of the report. Sorry I can't link it--still remote blogging.
Wednesday, August 22, 2007
Fat as metaphor
Meowser's comment on an earlier post got me thinking. She wrote:
"Whenever I see/hear anyone complaining about fat people walking around, or at the gym (where we're just piddling around and slowing things down for the buff crowd, you see, no fat person could possibly be getting an actual workout there), or dancing, or riding around on bikes, it totally gives the lie to the "unhealthy! unhealthy! diabetes! diabetes!" meme. Because people like that would totally rather we stay home and stuff our fat faces where they can't see us, rather than actually move around. I believe my mother cares about my health. I don't think some random stranger who doesn't know me really gives a damn if I'm "healthy" or not, and in fact, it would really piss them off no end if I had numbers proving that, apart from my weight, there is nothing wrong with me.'
I've been thinking as fat-as-a-symbol, the way it's most often used: as a metaphor for imperialism, greed, overconsumption, etc. Meowser's comment makes me wonder if it's also used as a symbol for questioning authority. Do fat people stick in the craw of the entitled thin establishment because we're not following the rules? Because we aren't doing whatever it takes to get thin, and stay thin? Do we piss them off because we're perceived as thumbing our noses at the authority figures?
I find it interesting that in a time of such extreme individualism, this is one area where being quirky, or not fitting the mold, is perceived as being unacceptable. We've become such a tolerant society in so many other ways. Though I know we have a long way to go on racism, still we've come a long way. When I was in college I was at the center of a near race riot, caused in part by my dating a black man and by the reactions of both whites and blacks on campus. That wouldn't happen today, not even in the deep south. The kind of anti-Semitism I bumped into as a child wouldn't be tolerated today, either.
So what is it about fat that gets people so riled up? Maybe fat people challenge, by our very existence, the marketing economy we can't escape. We're not buying into the pills, creams, products, etc. that are supposed to make us thin. (Though God knows many of us *have* bought those things, in the millions.) Maybe it's that fat people are perceived as not buying into the marketing imperatives about aesthetics, which are used to sell everything to everyone, from cars to cereal. We're not good consumers in the broadest sense of the word.
I wonder.
"Whenever I see/hear anyone complaining about fat people walking around, or at the gym (where we're just piddling around and slowing things down for the buff crowd, you see, no fat person could possibly be getting an actual workout there), or dancing, or riding around on bikes, it totally gives the lie to the "unhealthy! unhealthy! diabetes! diabetes!" meme. Because people like that would totally rather we stay home and stuff our fat faces where they can't see us, rather than actually move around. I believe my mother cares about my health. I don't think some random stranger who doesn't know me really gives a damn if I'm "healthy" or not, and in fact, it would really piss them off no end if I had numbers proving that, apart from my weight, there is nothing wrong with me.'
I've been thinking as fat-as-a-symbol, the way it's most often used: as a metaphor for imperialism, greed, overconsumption, etc. Meowser's comment makes me wonder if it's also used as a symbol for questioning authority. Do fat people stick in the craw of the entitled thin establishment because we're not following the rules? Because we aren't doing whatever it takes to get thin, and stay thin? Do we piss them off because we're perceived as thumbing our noses at the authority figures?
I find it interesting that in a time of such extreme individualism, this is one area where being quirky, or not fitting the mold, is perceived as being unacceptable. We've become such a tolerant society in so many other ways. Though I know we have a long way to go on racism, still we've come a long way. When I was in college I was at the center of a near race riot, caused in part by my dating a black man and by the reactions of both whites and blacks on campus. That wouldn't happen today, not even in the deep south. The kind of anti-Semitism I bumped into as a child wouldn't be tolerated today, either.
So what is it about fat that gets people so riled up? Maybe fat people challenge, by our very existence, the marketing economy we can't escape. We're not buying into the pills, creams, products, etc. that are supposed to make us thin. (Though God knows many of us *have* bought those things, in the millions.) Maybe it's that fat people are perceived as not buying into the marketing imperatives about aesthetics, which are used to sell everything to everyone, from cars to cereal. We're not good consumers in the broadest sense of the word.
I wonder.
Tuesday, August 21, 2007
And what's the point, anyway?
This whole you-can't-be-fat-and-fit, fat-is-always-unhealthy thing is really bugging me. Because really, what's the point?
The debate is beginning to remind me of my second-grade friend Linda Read, who had just learned in catechism that people like me--i.e., Jews--were going to burn in hell forever. And because she was my friend, she tried to convert me, of course, to spare me the suffering she knew was coming my way someday and forever.
Now let's say that guys like Walter Willett and Paul Raeburn (see previous post) are like my friend Linda. They really really believe that people like me--i.e., fat people--are going to health hell. Either we're going to get terrible diseases or we're just going to keel over at a tender age. (I once listened in astonishment to a neighbor talking about a certain fat actress on TV: "I can't even stand to watch her because I just know she's going to drop dead at any second!") So they set out to convert us.
But they know that it's not that simple. They know, for instance, that for most people dieting does not work, for a variety of reasons. Now here's where I really don't get it. Because you'd think the next tactic would be to encourage positive behaviors like fitness. Some fat people will lose weight that way; some won't. But we do know that being fit is a good thing no matter what your weight.
So why, then, do we get drivel like Raeburn's piece in Scientific American on how you can't be fat and fit?
Is the point to to shame us out of getting out there on our bikes and exercising? (I thought the photo at the front of that piece was exploitative.) Is the point to make us throw up our hands and say, "Well, no reason to bother exercising, since the only thing that counts is losing weight."
It feels so disingenuous. It feels like the point, such as it is, is fat bashing. So what if you're a triathlete--if you weigh 300 pounds then you can't possibly be healthy, so don't even bother.
And this bothers me far more than the other kind of health crusaders, the ones who are really like my friend Linda Read. Who worry for our fat souls, as it were, and want to save us.
These guys just want us to go to health hell already. And that makes me mad.
The debate is beginning to remind me of my second-grade friend Linda Read, who had just learned in catechism that people like me--i.e., Jews--were going to burn in hell forever. And because she was my friend, she tried to convert me, of course, to spare me the suffering she knew was coming my way someday and forever.
Now let's say that guys like Walter Willett and Paul Raeburn (see previous post) are like my friend Linda. They really really believe that people like me--i.e., fat people--are going to health hell. Either we're going to get terrible diseases or we're just going to keel over at a tender age. (I once listened in astonishment to a neighbor talking about a certain fat actress on TV: "I can't even stand to watch her because I just know she's going to drop dead at any second!") So they set out to convert us.
But they know that it's not that simple. They know, for instance, that for most people dieting does not work, for a variety of reasons. Now here's where I really don't get it. Because you'd think the next tactic would be to encourage positive behaviors like fitness. Some fat people will lose weight that way; some won't. But we do know that being fit is a good thing no matter what your weight.
So why, then, do we get drivel like Raeburn's piece in Scientific American on how you can't be fat and fit?
Is the point to to shame us out of getting out there on our bikes and exercising? (I thought the photo at the front of that piece was exploitative.) Is the point to make us throw up our hands and say, "Well, no reason to bother exercising, since the only thing that counts is losing weight."
It feels so disingenuous. It feels like the point, such as it is, is fat bashing. So what if you're a triathlete--if you weigh 300 pounds then you can't possibly be healthy, so don't even bother.
And this bothers me far more than the other kind of health crusaders, the ones who are really like my friend Linda Read. Who worry for our fat souls, as it were, and want to save us.
These guys just want us to go to health hell already. And that makes me mad.
Monday, August 20, 2007
Because he said so, dammit
This article by Paul Raeburn in the September issue of Scientific American, starts out well but quickly goes belly-up. So to speak. Raeburn's burning question--"Can fat be fit?"--is presented as genuine, but it's clear from the second graf that he's got an agenda rather than a genuine curiosity about the question.
He pays lip service to Katherine Flegal's research showing that being overweight (BMI between 25 and 30) may actually lower your risk of mortality. Flegal's drawn a lotta flak since her study came out, of course, and no doubt there's more to understand. But Raeburn doesn't try too hard. He sets Flegal up as a straw man and knocks her down fast with other research that seems less than compelling. He quotes Walter Willett of the Harvard School of Public Health, and writes, "Willett’s research has identified profound advantages to keeping weight down—even below the so-called healthy levels."
Here we have it once more, ladies and gentlemen, the mantra of so much that's being written these days about fat and thin. Flegal's research doesn't count because, as we all know, the lower your weight the better.
I can hear Willett saying, "Fat is too bad for you! [foot stomp] Why? Because I said so!"
I don't know Paul Raeburn's writing, but I do expect better than this paltry effort from Scientific American.
He pays lip service to Katherine Flegal's research showing that being overweight (BMI between 25 and 30) may actually lower your risk of mortality. Flegal's drawn a lotta flak since her study came out, of course, and no doubt there's more to understand. But Raeburn doesn't try too hard. He sets Flegal up as a straw man and knocks her down fast with other research that seems less than compelling. He quotes Walter Willett of the Harvard School of Public Health, and writes, "Willett’s research has identified profound advantages to keeping weight down—even below the so-called healthy levels."
Here we have it once more, ladies and gentlemen, the mantra of so much that's being written these days about fat and thin. Flegal's research doesn't count because, as we all know, the lower your weight the better.
I can hear Willett saying, "Fat is too bad for you! [foot stomp] Why? Because I said so!"
I don't know Paul Raeburn's writing, but I do expect better than this paltry effort from Scientific American.
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