comes this story from the International Journal of Obesity, which reports that there's something even worse for you than being too fat or too thin: thinking that you're too fat or too thin.
According to the article,
. . . individuals with overweight or underweight perceptions have an increased chance of experiencing medium (40 per cent and 50 per cent, respectively) and high levels of psychological distress (50 per cent and 120 per cent, respectively).
By comparison, being fat or thin in and of themselves were
not associated with psychological distress.
According to lead researcher Dr. Evan Atlantis from the University of Sydney, "weight perceptions that deviate from societal 'ideals' are more closely and consistently associated with psychological distress than actual weight status, regardless of weight misperception."
In other words, to misquote Maria Muldauer (and to make an unforgiveably bad pun), it ain't the meat, it's the emotion.
Atlantis went on to say, "Our findings suggest that public health initiatives targeting psychological distress at the population level may need to promote healthy attitudes towards body weight and self-acceptance, regardless of weight status."
Yup. We coulda told ya that. But it's nice to hear it from someone in the science community anyway.
Wednesday, October 31, 2007
Boycott this company
for its repulsive and unfunny Halloween costume glorifying and romanticizing the most lethal psychiatric disorder there is.
Write them a letter: 3WISHES.COM, Inc. 2144 East Lyon Station Road, Creedmoor, NC 27522. Better yet, call them on their own toll-free line: 800-438-6605.
Despicable.
Write them a letter: 3WISHES.COM, Inc. 2144 East Lyon Station Road, Creedmoor, NC 27522. Better yet, call them on their own toll-free line: 800-438-6605.
Despicable.
Sunday, October 28, 2007
New York Times blogger Judith Warner wrote recently an interesting post about migraines and her attempts to get off medication for them. Her new approach included an extremely restrictive diet, which eliminated coffee, chocolate, MSG, nuts, vinegar, citrus fruits, bananas, raspberries, avocados, onions, fresh bagels and donuts, pizza, yogurt, sour cream, ice cream, aspartame and all aged, cured, fermented, marinated, smoked, tenderized or nitrate-preserved meats.
It sounds something like the diet I went on when my children were very colicky babies, which cut out everything worth eating and left me, as Warner writes about herself,
ravenously hungry, cranky, spaced out and vaguely, deprivedly resentful. . . . But . . . once I got used to it, I came to almost enjoy being on my diet, exploring my capacity for hunger and self-abnegation, obsessing over what foods I could eat, and how, and when. At the very least, the diet made my friends happy. Renouncing food, renouncing pills, is so often, in our time, seen as the right and righteous, pure and wholesome thing to do.
That's certainly what I experienced on the colic diet: a sense of pride and self-righteousness that almost made it all worth it.
Knowing what I now know about eating disorders and how crucial reinforcement is in creating the feedback loop that sustains them, I wonder whether any kind of restrictive diet can put you into that mindset. Maybe if Warner or I were genetically susceptible to eating disorders, we'd have developed them.
It makes me even clearer that dieting is not a good idea, especially for teens, who are most vulnerable to the development of an eating disorder. Better to stay away from that kind of reinforcement.
For the record, Warner writes that while the migraine diet helped for a couple of weeks, it failed to cure her migraines. So she's back on meds and back to eating a more normal diet. Good for her.
It sounds something like the diet I went on when my children were very colicky babies, which cut out everything worth eating and left me, as Warner writes about herself,
ravenously hungry, cranky, spaced out and vaguely, deprivedly resentful. . . . But . . . once I got used to it, I came to almost enjoy being on my diet, exploring my capacity for hunger and self-abnegation, obsessing over what foods I could eat, and how, and when. At the very least, the diet made my friends happy. Renouncing food, renouncing pills, is so often, in our time, seen as the right and righteous, pure and wholesome thing to do.
That's certainly what I experienced on the colic diet: a sense of pride and self-righteousness that almost made it all worth it.
Knowing what I now know about eating disorders and how crucial reinforcement is in creating the feedback loop that sustains them, I wonder whether any kind of restrictive diet can put you into that mindset. Maybe if Warner or I were genetically susceptible to eating disorders, we'd have developed them.
It makes me even clearer that dieting is not a good idea, especially for teens, who are most vulnerable to the development of an eating disorder. Better to stay away from that kind of reinforcement.
For the record, Warner writes that while the migraine diet helped for a couple of weeks, it failed to cure her migraines. So she's back on meds and back to eating a more normal diet. Good for her.
Friday, October 26, 2007
One hospital that gets it
I'm deeply encouraged by a new study from the Children's Hospital at Westmead, in Sydney, Australia, where in 2002 clinicians set out to reduce the rate of readmissions and relapses they were seeing on the eating disorders ward. They began offering the Maudsley method for families with children and teens being discharged, and saw their readmission rates drop significantly.
They also identified four "practice challenges," aspects of treatment to pay attention, and I think three of them are worth repeating here because they get to the core of the challenges of family-based treatment.
1. Parallel process, or getting families and treatment providers on the same page. "Failure to achieve this tends to replicate the dynamic seen in a split parental team and leads to conflict, confusion and treatment failure," wrote the study's authors.
2. The therapeutic relationship with the family. "The therapists connection with the parents plays a significant role in helping them remain focused and energized for the task at hand. . . . The relationship for single parents with the therapist and supporting team is particularly significant, taking on an important role of emotional support that parallels the support that parents would give each other in an intact family."
3. Difficulty in predicting which families will succeed. "Clinicians need to maintain optimism and faith in a family's capacity, regardless of how they present."
Parents, if you're looking for treatment for your child, I hope you'll keep these important lessons in mind. Don't be afraid to bring them up with your treatment team.
They also identified four "practice challenges," aspects of treatment to pay attention, and I think three of them are worth repeating here because they get to the core of the challenges of family-based treatment.
1. Parallel process, or getting families and treatment providers on the same page. "Failure to achieve this tends to replicate the dynamic seen in a split parental team and leads to conflict, confusion and treatment failure," wrote the study's authors.
2. The therapeutic relationship with the family. "The therapists connection with the parents plays a significant role in helping them remain focused and energized for the task at hand. . . . The relationship for single parents with the therapist and supporting team is particularly significant, taking on an important role of emotional support that parallels the support that parents would give each other in an intact family."
3. Difficulty in predicting which families will succeed. "Clinicians need to maintain optimism and faith in a family's capacity, regardless of how they present."
Parents, if you're looking for treatment for your child, I hope you'll keep these important lessons in mind. Don't be afraid to bring them up with your treatment team.
Saturday, October 20, 2007
5 Things You Should Never Say
We've talked about the kind of corporeal self-loathing that's become institutionalized in American culture, especially among women. We've promised to try to love our own bodies. (Right?) Now let's take all that a step further and think about the kinds of things we say to one another about the way we and other people look.
Here's my vote for 5 things you should never, ever say to anyone. No matter how thin or fat s/he is. No matter how much you really want to. Because not one of these comments is helpful, and some are harmful--to you if not to the other person involved.
1. You look great! While there's nothing wrong with a sincere compliment, this is typically not sincere. It's usually code, meaning either You look great, you've lost some weight! or You look great even though you're still fat! Try, instead, something specific, like I love your hair like that. Better yet, skip the comments on other people's appearance and find something more interesting to talk about.
2. I never eat X. Maybe you're a vegetarian who hasn't eaten meat in 20 years. Maybe you're allergic to chocolate. Or maybe you're caught up in the good food/bad food syndrome, where the demon du jour is carbs or fat or whatever. My advice: Keep your food tics to yourself. Better yet, get over them. Learn to love your body and respect the fuel that keeps it going.
3. I guess you got the thin genes! This comment was actually directed to my daughter by a salesperson. I was the one shopping; I'd just come out of the dressing room with an outfit on. My daughter had recently been diagnosed with anorexia and was emaciated and awful looking; she was with me that day because she was too anxious to be home alone. This salesperson managed to insult both of us with one comment. I haven't shopped in that store (which used to be one of my favorites) since.
4. Aren't you worried about your health? Translation: You should damn well be worried about your health, you fatso. Given what we know about the tenuous to nonexistent relationship between weight and health (see Sandy Szwarc's righteous columns, Paul Campos' writings, Gina Kolata's book, and other up-to-date treatments of this subject), this comment is outdated and ineffective. And just plain cruel.
5. I wish I had a little anorexia! Do I need to tell you why this is a stupid, cruel thing to say? I don't think so. You realized that the minute it came out of your mouth.
Now that you've developed your inner editor, here's one thing you can always say: I love you. Repeat as needed.
Here's my vote for 5 things you should never, ever say to anyone. No matter how thin or fat s/he is. No matter how much you really want to. Because not one of these comments is helpful, and some are harmful--to you if not to the other person involved.
1. You look great! While there's nothing wrong with a sincere compliment, this is typically not sincere. It's usually code, meaning either You look great, you've lost some weight! or You look great even though you're still fat! Try, instead, something specific, like I love your hair like that. Better yet, skip the comments on other people's appearance and find something more interesting to talk about.
2. I never eat X. Maybe you're a vegetarian who hasn't eaten meat in 20 years. Maybe you're allergic to chocolate. Or maybe you're caught up in the good food/bad food syndrome, where the demon du jour is carbs or fat or whatever. My advice: Keep your food tics to yourself. Better yet, get over them. Learn to love your body and respect the fuel that keeps it going.
3. I guess you got the thin genes! This comment was actually directed to my daughter by a salesperson. I was the one shopping; I'd just come out of the dressing room with an outfit on. My daughter had recently been diagnosed with anorexia and was emaciated and awful looking; she was with me that day because she was too anxious to be home alone. This salesperson managed to insult both of us with one comment. I haven't shopped in that store (which used to be one of my favorites) since.
4. Aren't you worried about your health? Translation: You should damn well be worried about your health, you fatso. Given what we know about the tenuous to nonexistent relationship between weight and health (see Sandy Szwarc's righteous columns, Paul Campos' writings, Gina Kolata's book, and other up-to-date treatments of this subject), this comment is outdated and ineffective. And just plain cruel.
5. I wish I had a little anorexia! Do I need to tell you why this is a stupid, cruel thing to say? I don't think so. You realized that the minute it came out of your mouth.
Now that you've developed your inner editor, here's one thing you can always say: I love you. Repeat as needed.
Friday, October 19, 2007
National Love Your Body Day
In honor of National Love Your Body Day, I want to remind my readers to take the "I Love My Body" pledge.
Then check out the Love Your Body show.
Then do something fun for your body today--take a walk, eat some chocolate, go dancing,sunbathe (well, not if you live in Wisconsin). Be kind to your body and yourself. Doctor Harriet's orders.
Then check out the Love Your Body show.
Then do something fun for your body today--take a walk, eat some chocolate, go dancing,sunbathe (well, not if you live in Wisconsin). Be kind to your body and yourself. Doctor Harriet's orders.
Wednesday, October 17, 2007
Attention chocoholics
According to this study, there are two kinds of people in the world (metabolically speaking): chocolate lovers and those who are (can it be?) indifferent to chocolate's virtues.
The idea behind the study, frankly, smacks a bit of Big Brother:
This study by Swiss and British scientists breaks new ground in a rapidly emerging field that may eventually classify individuals on the basis of their metabolic type, or metabotype, which can ultimately be used to design healthier diets that are customized to an individual's needs.
I'm not sure I want to go there, or anywhere where someone is going to design a "healthier" diet just for me. Been there, done that (Weight Watchers, 1974).
Still, if it included chocolate, maybe it wouldn't be so bad. . . .
The idea behind the study, frankly, smacks a bit of Big Brother:
This study by Swiss and British scientists breaks new ground in a rapidly emerging field that may eventually classify individuals on the basis of their metabolic type, or metabotype, which can ultimately be used to design healthier diets that are customized to an individual's needs.
I'm not sure I want to go there, or anywhere where someone is going to design a "healthier" diet just for me. Been there, done that (Weight Watchers, 1974).
Still, if it included chocolate, maybe it wouldn't be so bad. . . .
Monday, October 15, 2007
Bet you won't see any mainstream news stories about this
And by "this" I'm referring to the results of the biggest clinical trial of healthy eating ever, as reported by Sandy Szwarc over at Junkfood Science. We're talking about part one of the Women's Health Initiative Dietary Modification Trial, which posted results like these:
• Healthy eating had no effects on rates of cardiovascular disease.
• Healthy eating had no effects on rates of breast or colorectal cancers.
• Women who followed a "healthy (lower-fat) diet did not wind up thinner.
• Women who didn't "watch what they ate" and ate more fat and calories didn't wind up fatter.
Did you read any news stories about this? Me neither.
Results from Part II are about to come out. I can't wait to not read those, too.
• Healthy eating had no effects on rates of cardiovascular disease.
• Healthy eating had no effects on rates of breast or colorectal cancers.
• Women who followed a "healthy (lower-fat) diet did not wind up thinner.
• Women who didn't "watch what they ate" and ate more fat and calories didn't wind up fatter.
Did you read any news stories about this? Me neither.
Results from Part II are about to come out. I can't wait to not read those, too.
Stick it to Ed (musically)
One of the great pleasures of the NEDA conference for me was meeting Jenni Schaefer, author of the book Life Without Ed. Jenni is a courageous and articulate advocate for all those who have struggled with eating disorders.
And she also happens to be a pretty rockin' songwriter, too! Her new single CD is called, what else, "Life Without Ed," and it's inspiring listening. Have a listen here. It's very cool.
And she also happens to be a pretty rockin' songwriter, too! Her new single CD is called, what else, "Life Without Ed," and it's inspiring listening. Have a listen here. It's very cool.
Do your Monday morning best for mental health parity
This just in from the Eating Disorders Coalition:
"Thank you for all your unified effort in supporting the passage of mental health parity! We are close to victory in the House of Representatives— to pass H.R. 1424, the “Paul Wellstone Mental Health and Addiction Equity Act”. This bill would require health plans to cover eating disorders and has made it out of 2 committees and the subcommittee of Energy and Commerce. The last step in order for the bill to go to the floor for a vote is to get moved out of the Energy & Commerce Full Committee. That mark-up is scheduled for next Tuesday, October 16th. We need your action on this!
If your Representative is a member of that Committee, please call him/her on Monday morning to urge a “YES” vote on the bill, and a “NO” vote on all weakening amendments!"
And here's the list of representatives on that crucial committee. If yours is on there, please give him or her a call. The EDC has even written a suggested script for you to say when you do call: "“I’m calling to ask the Congressman/woman to VOTE FOR H.R. 1424 on Tuesday in the Energy & Commerce Committee, and to VOTE AGAINST all amendments to substitute weaker language. Americans deserve the same mental health parity protections that members of Congress enjoy, for all mental and addictive disorders, not just the ones health plans choose to cover.”
Go forth and help make policy. And parity.
FULL COMMITTEE
John D. Dingell (MI), Chairman
Ratio: 31-26
Henry A. Waxman, CA Joe Barton, TX, Ranking Member
Edward J. Markey, MA Ralph M. Hall, TX
Rick Boucher, VA J. Dennis Hastert, IL
Edolphus Towns, NY Fred Upton, MI
Frank Pallone, Jr., NJ Cliff Stearns, FL
Bart Gordon, TN Nathan Deal, GA
Bobby L. Rush, IL Ed Whitfield, KY
Anna G. Eshoo, CA Barbara Cubin, WY
Bart Stupak, MI John Shimkus, IL
Eliot L. Engel, NY Heather Wilson, NM
Albert R. Wynn, MD John Shadegg, AZ
Gene Green, TX Charles W. "Chip" Pickering, MS
Diana DeGette, CO, Vice Chair Vito Fossella, NY
Lois Capps, CA Steve Buyer, IN
Mike Doyle, PA George Radanovich, CA
Jane Harman, CA Joseph R. Pitts, PA
Tom Allen, ME Mary Bono, CA
Jan Schakowsky, IL Greg Walden, OR
Hilda L. Solis, CA Lee Terry, NE
Charles A. Gonzalez, TX Mike Ferguson, NJ
Jay Inslee, WA Mike Rogers, MI
Tammy Baldwin, WI Sue Myrick, NC
Mike Ross, AR John Sullivan, OK
Darlene Hooley, OR Tim Murphy, PA
Anthony D. Weiner, NY Michael C. Burgess, TX
Jim Matheson, UT Marsha Blackburn, TN
G. K. Butterfield, NC
Charlie Melancon, LA
John Barrow, GA
Baron P. Hill, IN
"Thank you for all your unified effort in supporting the passage of mental health parity! We are close to victory in the House of Representatives— to pass H.R. 1424, the “Paul Wellstone Mental Health and Addiction Equity Act”. This bill would require health plans to cover eating disorders and has made it out of 2 committees and the subcommittee of Energy and Commerce. The last step in order for the bill to go to the floor for a vote is to get moved out of the Energy & Commerce Full Committee. That mark-up is scheduled for next Tuesday, October 16th. We need your action on this!
If your Representative is a member of that Committee, please call him/her on Monday morning to urge a “YES” vote on the bill, and a “NO” vote on all weakening amendments!"
And here's the list of representatives on that crucial committee. If yours is on there, please give him or her a call. The EDC has even written a suggested script for you to say when you do call: "“I’m calling to ask the Congressman/woman to VOTE FOR H.R. 1424 on Tuesday in the Energy & Commerce Committee, and to VOTE AGAINST all amendments to substitute weaker language. Americans deserve the same mental health parity protections that members of Congress enjoy, for all mental and addictive disorders, not just the ones health plans choose to cover.”
Go forth and help make policy. And parity.
FULL COMMITTEE
John D. Dingell (MI), Chairman
Ratio: 31-26
Henry A. Waxman, CA Joe Barton, TX, Ranking Member
Edward J. Markey, MA Ralph M. Hall, TX
Rick Boucher, VA J. Dennis Hastert, IL
Edolphus Towns, NY Fred Upton, MI
Frank Pallone, Jr., NJ Cliff Stearns, FL
Bart Gordon, TN Nathan Deal, GA
Bobby L. Rush, IL Ed Whitfield, KY
Anna G. Eshoo, CA Barbara Cubin, WY
Bart Stupak, MI John Shimkus, IL
Eliot L. Engel, NY Heather Wilson, NM
Albert R. Wynn, MD John Shadegg, AZ
Gene Green, TX Charles W. "Chip" Pickering, MS
Diana DeGette, CO, Vice Chair Vito Fossella, NY
Lois Capps, CA Steve Buyer, IN
Mike Doyle, PA George Radanovich, CA
Jane Harman, CA Joseph R. Pitts, PA
Tom Allen, ME Mary Bono, CA
Jan Schakowsky, IL Greg Walden, OR
Hilda L. Solis, CA Lee Terry, NE
Charles A. Gonzalez, TX Mike Ferguson, NJ
Jay Inslee, WA Mike Rogers, MI
Tammy Baldwin, WI Sue Myrick, NC
Mike Ross, AR John Sullivan, OK
Darlene Hooley, OR Tim Murphy, PA
Anthony D. Weiner, NY Michael C. Burgess, TX
Jim Matheson, UT Marsha Blackburn, TN
G. K. Butterfield, NC
Charlie Melancon, LA
John Barrow, GA
Baron P. Hill, IN
Saturday, October 13, 2007
See a video on Maudsley
Here at NBC Chicago. Try not to pay attention to the misleading title, and you will have to watch a short ad before the video loads, and of course there are the usual caveats at the end of the piece. But it seems like a good look at an ordinary family who are helping their daughter through family-based treatment Features Dan Le Grange. I think it's worth a watch.
Thursday, October 11, 2007
I just don't get it
It is just shocking to me that so many people misperceive and fear family-based treatment.
I'm no dummy: I know even FBT is no panacea. It won't cure everyone. But it cures a damn sight more folks than anything else we've got. And a lot quicker, too.
So what's the problem? We don't advise against penicillin because some people are allergic to it, do we? We don't dismiss Prozac because hey, it doesn't work for everyone.
So why are people so dismissive of Maudsley? I'm talking about people who haven't worked with it, who are going only by what others say about it.
Maybe it's like a generic medication--there's no big money to be made on it, so there's no incentive to fall in love with it.
But as Daniel Le Grange said to me recently, "We're not doing very well by our children." FBT helps children and adolescents, no question about it. The statistics are very good--80 to 90 percent of those treated with it are still recovered after five years.
FBT doesn't get into cause. It doesn't have an opinion, so to speak, on psychodynamic issues. It rather neatly sidesteps them, at least for phase 1 of treatment--weight restoration.
Is there anyone out there who can truly argue with the need for someone who is severely malnourished to gain weight?
I just don't get it.
I'm no dummy: I know even FBT is no panacea. It won't cure everyone. But it cures a damn sight more folks than anything else we've got. And a lot quicker, too.
So what's the problem? We don't advise against penicillin because some people are allergic to it, do we? We don't dismiss Prozac because hey, it doesn't work for everyone.
So why are people so dismissive of Maudsley? I'm talking about people who haven't worked with it, who are going only by what others say about it.
Maybe it's like a generic medication--there's no big money to be made on it, so there's no incentive to fall in love with it.
But as Daniel Le Grange said to me recently, "We're not doing very well by our children." FBT helps children and adolescents, no question about it. The statistics are very good--80 to 90 percent of those treated with it are still recovered after five years.
FBT doesn't get into cause. It doesn't have an opinion, so to speak, on psychodynamic issues. It rather neatly sidesteps them, at least for phase 1 of treatment--weight restoration.
Is there anyone out there who can truly argue with the need for someone who is severely malnourished to gain weight?
I just don't get it.
Tuesday, October 09, 2007
6 lessons I learned at NEDA
1. There are lots and lots of well-meaning but ineffectual folks working in the eating disorders field.
2. There is lots and lots of Big Money at stake in the eating disorders field, mostly in the form of residential treatment centers.
3. There are lots and lots of politics in the eating disorders field.
4. Family-based treatment, which the scientific literature recognizes right now as the only evidence-based treatment with an 80 to 90 percent long-term success rate in adolescents, is perceived as controversial in the eating disorders field, even by some of those who profess to support and use it.
5. The most commonly heard comment about FBT at the conference: "Don't you have to be a very special family to make it work?"
6. The intensive outpatient family therapy for eating disorders program at University of California-San Diego, headed by Dr. Walter Kaye, looks absolutely wonderful.
I'm sure there are more, and I'm sure I'll be posting about them too.
2. There is lots and lots of Big Money at stake in the eating disorders field, mostly in the form of residential treatment centers.
3. There are lots and lots of politics in the eating disorders field.
4. Family-based treatment, which the scientific literature recognizes right now as the only evidence-based treatment with an 80 to 90 percent long-term success rate in adolescents, is perceived as controversial in the eating disorders field, even by some of those who profess to support and use it.
5. The most commonly heard comment about FBT at the conference: "Don't you have to be a very special family to make it work?"
6. The intensive outpatient family therapy for eating disorders program at University of California-San Diego, headed by Dr. Walter Kaye, looks absolutely wonderful.
I'm sure there are more, and I'm sure I'll be posting about them too.
Sunday, October 07, 2007
Sunday morning at NEDA
The NEDA conference is officially over, but I've still got a bag full of brochures and other stuff I collected here (and I'm not going home until tomorrow morning), so I thought I'd offer another deconstruction of e.d. programs and what they offer to parents.
The reason I'm doing this, by the way, is not just to make enemies (though I'm sure I am) but to try to offer one parent's view of what's on offer. I think it's especially important given a snippet of conversation I had yesterday with one of the long-time NEDA folks, whose comment about Maudsley was, "But you have to be a very, very special family to make that work, don't you?" This is, of course, the mainstream view, and of course it's completely erroneous. It's part of the disempowerment of parents within the eating disorders field that just burns my boat.
So. Within that context, it's not surprising to find brochures like the one I picked up from the Women's Center at Pine Grove, in Hattiesburg, Mississippi, a treatment facility that treats e.d.s, addictions, and both. Here are some of the phrases that jumped out at me from this 12-page glossy brochure: "Components of the treatment experience include understanding the disease process and the camouflaged self, helping women reclaim and celebrate their feminine spirit, empowering women to come to their own assistance. . . . " There's a family week--sounds good, right?--described as "40 hours of intensive therapy where the healing process between family members begins." OK, this center is for women strugglng with addiction as well as e.d.s, and does not seem geared toward adolescents. There are photos of lovely flower arrangements and wooden staircases. Under Amenities, the brochure says, "We offer gender-responsive treatment in a quiet, peaceful, and secluded environment." I'm not sure what gender-responsive treatment means. The next paragraph goes on: "We encourage our patients to take advantage of the nearby YMCA . . . a facility that includes weights, cardiovascular equipment, indoor track and pool, indoor racquetball and basketball course."
Hello? For women in the throes of anorexia?
Nowhere in this brochure is there any mention of food or eating. Nowhere. There is one line under "Components of Treatment" that says "Nutritional counseling." It's about halfway down a list that includes items like "Boundaries & Relationships," "Exercise & Fitness," and "Psychodrama."
I don't think so.
The reason I'm doing this, by the way, is not just to make enemies (though I'm sure I am) but to try to offer one parent's view of what's on offer. I think it's especially important given a snippet of conversation I had yesterday with one of the long-time NEDA folks, whose comment about Maudsley was, "But you have to be a very, very special family to make that work, don't you?" This is, of course, the mainstream view, and of course it's completely erroneous. It's part of the disempowerment of parents within the eating disorders field that just burns my boat.
So. Within that context, it's not surprising to find brochures like the one I picked up from the Women's Center at Pine Grove, in Hattiesburg, Mississippi, a treatment facility that treats e.d.s, addictions, and both. Here are some of the phrases that jumped out at me from this 12-page glossy brochure: "Components of the treatment experience include understanding the disease process and the camouflaged self, helping women reclaim and celebrate their feminine spirit, empowering women to come to their own assistance. . . . " There's a family week--sounds good, right?--described as "40 hours of intensive therapy where the healing process between family members begins." OK, this center is for women strugglng with addiction as well as e.d.s, and does not seem geared toward adolescents. There are photos of lovely flower arrangements and wooden staircases. Under Amenities, the brochure says, "We offer gender-responsive treatment in a quiet, peaceful, and secluded environment." I'm not sure what gender-responsive treatment means. The next paragraph goes on: "We encourage our patients to take advantage of the nearby YMCA . . . a facility that includes weights, cardiovascular equipment, indoor track and pool, indoor racquetball and basketball course."
Hello? For women in the throes of anorexia?
Nowhere in this brochure is there any mention of food or eating. Nowhere. There is one line under "Components of Treatment" that says "Nutritional counseling." It's about halfway down a list that includes items like "Boundaries & Relationships," "Exercise & Fitness," and "Psychodrama."
I don't think so.
Saturday, October 06, 2007
Saturday morning at NEDA
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?
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?
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!
Subscribe to:
Posts (Atom)