Ludicrosity

This new "study" deserves its very own made-up word--that's how utterly ridiculous and misleading it is.

It's a classic case of distortion, from the headline--"Obese? Drive at Your Own Risk!"--to the bait-and-switch of its conclusion. Based on research involving people in car accidents, it purports to look at how BMI affects your risk of dying in a car accident.

Here's how it opens:

Being obese may increase the risk of perilous diseases like diabetes, heart attack, stroke and cancer. And it can be fatal in one more way -- it enhances the risk of dying in a car crash.

What's the connection? Well might you ask. This is one of those reviews masquerading as a study, where researchers look at data--in this case, data on people involved in car accidents and their BMI.

Researchers divided over 230,000 people into groups based on their body mass index (BMI) . The rate of always wearing seat belts was 82.6 per cent for non-obese motorists (BMI less than 25), 80.1 per cent for overweight motorists (BMI 25-29), 76.6 per cent for obese motorists (BMI 30-39) and 69.8 per cent for extremely obese motorists (BMI 40 and above). The gap climbed from 2.5 per cent for overweight, to 6.0 per cent among the obese, to 12.8 per cent among the extremely obese.

Um, what we've got here is a correlation between not wearing your seat belt and dying in a car crash, along with a statistical analysis of percentage of seat belt wearers and their BMI.

As Sandy Szwarc is fond of saying correlation is not causation. Or, to put it another way: The media is willing, but the evidence is weak.

Practicing with a license

I've given serious thought to going back to school and getting an MSW so I could get licensed as a therapist and work with people who have eating disorders. I've often felt this year like I was practicing without a license--giving therapeutic advice while not being a therapist or having any medical training myself--and wondered if I should get some training.

And I probably will get more training, at some point. But this advice column reminded me that a license doesn't necessarily mean that a) you know what you're talking about, or b) you give good advice.

It's written by someone with an MSW who displays appalling ignorance about eating disorders and the state of treatment. She sounds a lot like the first therapist we saw when my daughter was diagnosed with anorexia. A mother wrote in about her young daughter, who she believes is showing signs of anorexia, and this social worker responded by, first, pooh-poohing the mother's sense of her daughter's health:

Though child anorexia is now being diagnosed in girls as young as six years old, my gut tells me that it’s not the case here. X's weight is stable, and girls suffering from anorexia usually exhibit a rapid and profound weight loss.

Wrong, wrong, wrong. That's what I thought when my daughter got sick, and because she hadn't lost a lot of weight, I figured she couldn't have anorexia. In fact with children and adolescents the issue is often a failure to gain weight rather than a dramatic weight loss. When you weigh only 70 pounds to begin with, it doesn't take much to tip you into a state of malnutrition.

The therapist goes on to say that

Anorexia, which is an eating disorder, is linked to an emotional problem. It is not about food, but rather about feelings. These are often feelings of intense levels of tension and anxiety, or an inability to cope with one’s surroundings. It’s complicated, and it’s certainly not something that most parents would be qualified to “fix.”

Wrong again on every count. As readers of this blog already know, the latest research on eating disorders shows that they are biological illnesses--brain disorders. The head of NIMH has gone on the record saying so. And while they surely are complicated illnesses, there's no one in a better position to help "fix" them than a parent, because the treatment is food. Not psychobabble*. Not circular discussions about feelings. There may be value in therapy, but later on, when the brain is nourished and working properly again.

I guess having a license doesn't mean you know what you're talking about. And not having one doesn't mean you don't. I won't be going back to school but I'm going to keep on trying to educate families and professionals about the realities of eating disorders until the so-called professionals get a clue.


*Apologies to my therapist friends. I'm a big believer in therapy--just not for someone who's acutely malnourished. Food first, talk later.

Would you rather be fat or live another 20 years?

Readers of this blog have no doubt heard about the study* that showed a shockingly high percentage of people would rather be blind, lose a limb, live a shortened lifespan, and suffer other calamities--so long as they didn't have to be fat.

Now a new study may put that fatphobia to the test. Researchers at the Fred Hutchinson Cancer Research Center in Seattle have found that nematode worms who were exposed to one of the tricyclic antidepressants lived up to 30 percent longer lifespans. Their hypothesis: the drug disturbed the balance of chemicals in the brain and created a "perceived, but not real" state of starvation that altered the creatures' natural lifespans.**

Sounds like sci fi, doesn't it? After all, humans have been chasing a longer lifespan since Ponce de Leon hunted for that fountain--and probably long before that. But wait, said the researchers, even if this effect could be shown in people, they're not going to go for it, because that class of medications causes "weight gain and increased appetite."

So someday we really might be faced with a choice between being fat and living significantly longer.

What would *you* do?

*See www.yale.edu/opa/newsr/06-05-16-02.all.html
** See www.news-medical.net/?id=32859

Want to lose weight fast?

Carrie over at Ed-Bites has some brilliant ideas for you.*



*Please note: My tongue is inserted firmly in my cheek.

Mom's off the hook, Dad's on the hot seat

For the last 60 years or so, parents have been blamed for their children's eating disorders. Doctors have believed, and said, that anorexia and bulimia are caused by overcontrolling parents, by abusive parents, by sexual trauma, by inattentive parents, by cold parents, hypercritical parents. New research on the biology of eating disorders has slowly begun to offer an alternative to the blame game--a combination of genetics, biology, and environment is probably responsible for eating disorders, or so goes the latest thinking. (Though some folks clearly have some catching up to do on this score.)

Now a study from Australia points the finger once more at parents--specifically fathers, who are charged with contributing to a child's anorexia when they exert too much control. Mothers, on the other hand, played no apparent role.

I haven't read the original study, but the article reporting it makes me wonder how, exactly, this data was gathered. Reading between the lines, it seems the descriptions of the paternal relationships were reported by the teens with anorexia. Well, they'd have to be, wouldn't they?

Anyone who's parented a teen with anorexia knows that someone in the grip of an eating disorder may reflect a lot of anger toward parents, especially if those parents are insisting that the teen eat. It's really not the teen talking but the disease, which famously warps perceptions and behaviors.

While I'm sure there are overcontrolling fathers out there who contribute to their child's unhappiness in various ways, I'm a little leery of this kind of thing being reported as fact in a scientific study--and of what may come of it down the line.

As Daniel Le Grange once pointed out to me, by the time families come in for help with a teen's eating disorder, they tend to look pretty overcontrolling, because they're terrified at their child's behavior and frightened for her/his health and life. So even if the observations are made by someone outside the family, I wonder how meaningful observations made in a time of family crisis really are when thinking about causation.

God knows we need more studies about anorexia and bulimia--the lack of them is in part responsible for the dreadful lack of effective treatment options. I just wonder if this is the best use of research dollars. Wouldn't the money and time be better spent looking at ways to help teens recover rather than blaming their parents?

Um, just a thought.

O.M.G.

That's about all I can say right now about this destructive, damaging, obscene board game meant for preschoolers. It's about as subtle as a fart gag, and about a million times more noxious, because it seems designed to turn young children into budding anorexics.

The incomparable Sandy Szwarc had a lot to say about this today. As she points out, "[The game] teaches that foods, especially “bad” foods, make them fat. The message illustrated is that when a food is eaten, they must purge by expending a certain number of calories in exercise to avoid getting fat. Calorie counting before they can count."

The game reminds me of another ill-advised project of the last year, the inexplicable collaboration between two of my favorite children's authors on a book demonizing fat people and making plenty o' assumptions about them.

May Hungry Hank go the way of The Gulps. And fast.

Talking to middle school staff

Yesterday I made the first of what I hope will be many presentations to middle school staff--at my younger daughter's middle school, because that seemed like a good place to start. I'd put together a PowerPoint on 6 things I wanted them to know about eating disorders and 8 ways they could help.

The group was smaller than I'd hoped for, but they were really engaged. These are people who do truly care about the lives of kids. I was very heartened by that. Like doctors, they don't get any special training in eating disorders, and they're often frustrated and frightened by what they see.

I was also heartened by a conversation we got into on the "wellness" curricula--the same cockamamie stuff that bans syrup from elementary school lunchrooms and forbids a second slice of pizza to 4th-graders. One of the messages I tried to convey was how the increasing and heavy-handed emphasis on "eating healthy" and the war on obesity as played out in the schools was likely to trigger more eating disorders. It certainly sends a screwed-up message to kids and disrupts their lifelong relationship with food and eating. I'd braced myself for pushback along the lines of "Well kids are unhealthy and it's our job to help them learn to control themselves!" Instead, I got lots of nodding heads and comments about how worried they, teachers and staff, are about the shrill curriculum.

That made me feel good. There is room to broach these subjects, in public, and to begin a dialogue on them. Nothing changes if we just sit at home bitterly blogging about this stuff. We've got to get out in the real world, say our piece, and talk about it.

Syrupgate

It all started innocently enough, with a 4th-grader and a school lunch. Said 4th-grader was having the school's hot lunch that day--French Toast Stix [sic]--and mentioned to her mother that maple syrup was no longer served with this, um, lunch, thanks to the new "wellness" policy in our school district.

So Mom sent along the tail end of a bottle of maple syrup with 4th-grader. And Mom got a phone call the very next day, reminding her that it is not OK to send in maple syrup, which is now apparently considered a controlled substance in the lunchroom.

Of course, I can see why maple syrup would be banned from an elementary school lunchroom. It's way too unhealthy to be eaten by children. And it no doubt contributes to the Obesity Epidemic! Whereas serving deep-fried bread sticks--or stix--does not.

No less a personage than the principal herself got involved in Syrupgate, because there's nothing more important than our children's BMIs (I mean health).

It's the same ridiculous pseudo-reasoning that limits all children in elementary schools here to one and only one slice of pizza on pizza day. Have you ever seen an elementary-school-size slice of pizza? It wouldn't fill a rat's stomach for an hour, let alone the stomach of a growing child for the rest of the afternoon.

Two slices of pizza and a swig of maple syrup might satisfy the children's hunger . . . but it might also Make Them Fat. And we all know it's better to be hungry than to be fat, right?

At least in my town.

"Mom, I'm too fat!"

These are the words to strike terror into a mother's heart, especially if you've ever dealt with anorexia or bulimia in your house. Every child or teen with an eating disorder says these words at one time or another. They reflect the delusion at the heart of an eating disorder, the distorted perceptions of her/his own body and the anguish caused by those distortions.

I heard them many times in the year my older daughter was sick with anorexia. But this time, this weekend, they were uttered by my younger daughter.

My younger daughter sat with us at the table during the year and a half of re-feeding. She lived through the horror and terror of it all with us. We tried to protect her from the worst of it, but she certainly experienced firsthand the nightmare of living with an eating disorder. This may contribute to the reality that as the sibling of a child with anorexia, she's 8 times more likely to have it than other kids her age.

And we've talked about it. Boy, have we talked. We've talked about unrealistic body images and the media. We've talked about food-as-fuel. We've talked about bodies-come-in-all-shapes-and-sizes. We've talked about health-at-every-size.

I thought we'd talked our way through the dangerous parts and onto the solid shores of reason and understanding.

But the trouble is, as my younger daughter informed me, I just don't understand. I don't understand what it's like to be in 7th grade and be a girl. I don't understand what it's like to be a year or two behind when it comes to puberty, to still have a child's body, a child's shape, in a world full of budding young women.

"They look like this, Mom," she cried one night this weekend, sucking in her stomach to show me. Whereas my younger daughter still has the round shape of a child. She's younger than everyone else in her class, shorter, and clearly going through puberty later.

I don't think other kids are making fun of her for her childish figure. I think this is a case of institutionalized self-loathing. But I don't know for sure. I do know that seventh grade girls diet. A lot. And that they talk about their diets. And they talk, as young women (and some young men) do, about how fat they are.

They talk about how fat their butts and thighs and stomachs are. I know these kids; I've chaperoned them on field trips and come into their classrooms for years. They are not fat. They are not the headless fat children whose photos you see accompanying every media scare on the subject of childhood obesity. They look no different from kids of my generation, except that maybe they're a little taller.

Even if they were fat, of course, it would make no difference.

These children are bombarded with media images of super-thin women and men, and so that body type and paradigm comes to look very normal to them. They watch a lot of TV and movies and they learn to see themselves as sexualized from an early age.

They're bombarded at school with hysterical warnings about body fat and obesity and unhealthy eating. They are forced to watch Supersize Me. They are weighed and their BMIs calculated, in front of other children. Their body fat is "measured" (however inaccurately) with calipers, all in front of other children. They are taught that there's good food and bad food, that some foods are unhealthy, that some bodies are unacceptable. They're taught that you can never strive hard enough to be thin, to exercise, to avoid certain foods.

Some of them develop eating disorders. Maybe they would anyway; there's no way to know. We do know that some kids come hard-wired to be susceptible to an e.d., and that those disorders can then be triggered by environment and other factors. So maybe if they grew up in a culture that wasn't obsessed by issues of weight and body size and shape, they would pass through the dangerous time of adolescence without ever developing an e.d. If they grew up in a culture where it was OK to be who you are--fat or thin, intellectual or street-savvy, funny or serious--they would come out of adolescence loving themselves, not hating who they are.

Maybe this is all wishful, deluded thinking on my part.

I do know that those words my younger daughter said struck pure terror into my heart. That we will be talking about this from every direction I can think of over the next few months and years. That I'll be watching her like a hawk for the first inklings of an eating disorder, watching with terror a lump in my throat, with the memories of my older daughter still fresh, and with the determination to do whatever it takes to save her if she is in fact in danger.

But my god, how I wish I didn't have to. It occurs to me for pretty much the first time how different this would feel is the culture supported me rather than fought me. But in this culture and time, to advocate for, as Ellyn Satter says, a "joyful, comptent relationship with food," is to swim against the current, to fight the mainstream, to be perceived in many ways and places as a nutcase, a fruitcake, a mom-with-an-agenda in the worst possible sense of the word.

I've developed a thick skin. I don't care what the powers that be think. I care only about my children, and other people's children. But it's so easy to buy in to the culture's sick obsession. So easy, in a certain way, to turn to my younger daughter and say, "You do have a little tummy, dear--why don't we go on a diet? Together?" To unwittingly set her up for either a lifetime of physical self-loathing or disordered eating, or the hell of a full-blown eating disorder.

Not today. Not my daughter.

Media misunderstandings

I suppose I should be glad that my local newspaper is covering eating disorders in this article on a 41-year-old woman with bulimia.

But you know, it's hard to feel encouraged when you read lines like this:

Thanksgiving, challenging for anyone on a diet, is particularly problematic for people with eating disorders, whose troubles with food generally stem from deep psychological issues, therapists say.

There's a whole lotta sloppy thinking and reporting packed into that one paragraph. For one thing, it conflates "anyone on a diet" with "people with eating disorders," as if an eating disorder was the same phenomenon as a diet, only taken to an extreme.

And of course the line about "deep psychological issues" is just the same old b.s. we've been hearing since Hilde Bruch started writing about anorexia.

We know a hell of a lot more about these diseases now than Bruch did. We know they're biological illnesses. We know that genetics plays a huge role. And we know that you don't need "psychological issues" to develop anorexia or bulimia.

SOmeone who's lived with an e.d. for 20-some years may well have "deep psychological issues" with food. But it's a chicken and egg thing. The illness comes first, the "issues" come later.

The article goes on to describe how the woman with bulimia has been hospitalized seven times (six times at Rogers Memorial) for her eating disorder and still struggles with it. The tone smacks of prurience--"She actually might get up from the Thanksgiving table and vomit!"--and the continued conflation of eating disorders and dieting leads to comments like "Therapists encourage people with eating disorders — and anyone with more routine concerns about overeating on Thanksgiving — to plan ahead. Consider what items might be served and decide how much of each you'll eat."

Um, that sounds exactly like eating disorder talk to me.

It's all about the food

I love this article, which talks about new research showing that when it comes to getting nutritional bang for your buck, it's food itself rather than supplements, vitamins, etc. that holds the key.

The article refers to recent studies that have looked at whether ingesting specific nutrients--B vitamins and beta-carotene--can prevent heart disease, cancer, and other ailments. All of these studies so far have shown no value, or even a slight negative value, to the supplement approach.

These researchers argue that it's the food, not what's in it, that's good for us. Sitting down to a plate of steamed kale with olive oil and garlic is an entirely different matter, nutritionally, than dosing yourself with B-vitamins, iron, etc. This follows along with conclusions from a 1970s study showing that when you enjoy what you're eating, you actually get more nutritional value from it. Shocking!

Here's the money quote in my book:

[Researchers] focus on the concept of food synergy - the idea that more information about the impact of human health can be obtained by looking at whole foods than a single food component (such as vitamin C, or calcium added to a container of orange juice).

Just as some of us have been saying all along, food is medicine.

So on this Thanksgiving week, lift a fork in honor of the pleasures and privileges of food. Say thanks to your body, a splendid machine that knows how to make use of food, and to your taste buds, which let you enjoy it.

Then dig in.

The obesity paradox, redux

In the category of why-is-this-so-hard-to-believe, Reuters reports that the effects of the so-called "obesity paradox" have prevailed in yet another study, this one on people with heart disease and high blood pressure.

The results substantiate earlier results showing the now-famous J-shaped mortality curve described by Dr. Katherine Flegal, wherein overall mortality rates are highest at either end of the spectrum and lowest in those in the "overweight" category. What's significant about this study is that it concentrated on people with heart disease--who are, if you listen to the media at all on this subject, in imminent danger of death if they carry even a couple of "extra" pounds.

This study of 22,576 people with high blood pressure and coronary artery disease found that

compared to normal-weight subjects with a BMI between 20 and 25, the risk of death, heart attack, or stroke was lower in subjects who were overweight (BMI 25 to 30), and in those with class I obesity (BMI 30 to 35) and class II-III obesity (BMI 35 or greater).

The article is accompanied by--what else?--the obligatory shot of headless fatties. And its wrap-up leaves something to be desired:

In a commentary, Dr. Carl J. Lavie and colleagues of the Ochsner Medical Center, New Orleans caution that while improved outcomes appear to be consistently associated with increased BMI, "one should not conclude that weight reduction is detrimental in overweight populations."

I'm not sure what we should be concluding then, except that the media coverage on this subject is, as usual, beyond biased.

And the next Leaden Fork award goes to . . .

Dr. John Tickell, billed as an "Australian expert in nutrition and weight control," for his passionate campaign to charge obese airline passengers extra for being fat.

"Airlines are buying fuel, and if you are carrying a heavy weight on a plane you have to pay more for it. But instead, the rest of the public is paying for it. It's got to be restricted," said Tickell.

Uh-oh. Do I hear the sound of thin entitlement?

Tickell went on to greater heights of hyperbole with this comment: "Flight attendants in the US have to go down the aisle handing extension seatbelts out like headphones."

Maybe he'd prefer that fat people didn't wear seat belts on a plane. Maybe some bruises and broken bones in case of turbulence would open our eyes to the fact that , golly, we're fat!

Turns out Tickell is ticked off because he was once charged $100 to check golf clubs, while a passenger who "outweighed him and his golf clubs" didn't have to pay extra.

Maybe security should just require surgical removal of excess fat at the checkpoint. That would solve the problem, right, Dr. Tickell?

What we all can do

A young woman I didn’t know died last week. She was bright and talented and had many interests—acting, writing, music. She wanted to teach and have a family when she grew up. Only she’s never going to grow up.

I didn’t know this young woman, but I know the kind of disease that killed her, because it nearly killed my daughter. We don’t talk about these illnesses much. We don’t talk about the fact that one of them is the deadliest psychiatric disease, or that it kills 20 percent of its victims and makes life hell for the other 80 percent—for a year, for five years, forever.

We don’t talk about it because so many people still think that people with these diseases are spoiled rich kids acting out, looking for attention, or trying to punish their parents. They think these illnesses are a lifestyle choice, and they can’t imagine why anyone would choose it.

The diseases are eating disorders. The reality is that people don’t choose them and can no more choose to recover from them than you can choose to cure yourself of cancer.

I don’t know this young woman’s family, but I know something of what they’ve gone through, because our family went through it, too. Lots of families in my community have gone through it, but few will talk about it. They don’t talk about how an eating disorder steals a teenager’s life, or how insidious it is, and they sure as hell don’t talk about how deeply ashamed and guilty they are about their child’s illness.

There are doctors and nurses in my community who still blame families when a child has an eating disorder. Who will tell you, with a look of disdain, that you did this to your child. You’re the reason your child weighs 70 pounds and is too weak to sit up in bed. You’re the reason your bright, charming, funny child can do nothing but shake and cry and still, even though she’s starving to death, cannot eat. You're the reason your National Merit Scholar throws up everything she eats. It’s because of you that your child has died, because you’re too smothering, too cold, too enmeshed, too anxious, too controlling, too permissive.

The latest research on eating disorders clearly shows that genetics and biology are the biggest risk factor for an eating disorder. But we as a society haven’t caught up to scientific reality yet. We still blame families, the way we used to blame them for autism and schizophrenia and homosexuality. We still brand them with a devastating stigma.

And as long as this shame and stigma prevail, other young women and men will suffer and die. We need more effective and more evidence-based treatments for eating disorders, and one reason we don’t have them is because so little research has been done. And one reason for that is that so few parents are able or willing to step up and become advocates for their children. The stigma and shame are too great.

We can do better than this. As a community, we can come together around a family struggling with an eating disorder the way we come together for families struggling with cancer or other terrible illnesses. Our children need compassion and empathy. They need us to understand that they don’t choose to have an eating disorder and they can’t unchoose it. They need and deserve better treatments and more understanding.

I cried when I read this young woman’s obituary. I cried for a girl I will never know. I cried for my daughter and for all the young women in this community and elsewhere who are battling the demons of an eating disorder.

My tears won’t change a thing. But I’m hoping my words will change the way you think about anorexia and bulimia. And the next time you hear about a child who’s been diagnosed with anorexia or bulimia, instead of wondering what went wrong in that family, you’ll wonder instead what you can do to support them through the most terrible and difficult time of their lives.

In the category of "We coulda told ya"

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.

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.

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.

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.

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.

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.