Fat matters

If you're a regular reader of this blog, you know that my family used the Maudsley approach to help our 14-year-old daughter recover from anorexia. (Here's a link to the whole story as published in the New York Times Magazine.)

In Maudsley, parents take charge of their child's eating while they're in recovery. So it was up to my husband and me to devise meal plans for our daughter. Like most anorexics, she needed a lot of calories each day to gain weight--upwards of 4,000 calories a day during one phase of recovery. Because the act of eating was so terrifying and difficult for her, and because, like most anorexics, she endured many stomachaches, our strategy was to get as many calories as possible into the smallest volume of food.

What this meant, practically, was that our daughter ate a lot of high-quality, high-fat and -protein foods: Almond butter. Ice cream. Mac and cheese. (Some of our favorite recipes are here.)

Now this study confirms our instincts about what to feed our daughter. Fat, it seems, matters a lot when it comes to recovery from anorexia. Recovering anorexics who ate higher-density (translation: higher fat) foods were less vulnerable to relapse. I could speculate about why, but the bottom line is that for true recovery, you've got to eat fat. Lots of it. Not just x number of calories, but high-fat calories.

Fat can make the difference between true recovery and a lifetime of suffering.

Fat matters.

Drug money and DSM

Tara Parker-Pope's blog about DSM, the psychiatric bible, and ties to Big Pharma, hits on a point of particular interest to anyone who's had experience of an eating disorder.

The truth is that there are few if any medications that have been shown to help treat an eating disorder, especially in the acute phase of the illness (and isn't that when you want them to help?). Psychotropic meds do not seem to help when someone is severely malnourished through anorexia or bulimia. (There are a few atypical anti-psychotics being looked at for treatment, but the jury is still way out on those.)

Despite the accumulating evidence that meds are not the first-line treatment for eating disorders, pretty much every doc you'd see for an e.d. will prescribe an SSRI, or several.

In my daughter's case, she had bad reactions to nearly everything she was put on, which meant more suffering was piled on top of what she was already going through. Oh, and we had to pay big bucks for it, too.

Of course, my daughter was never officially diagnosed with anorexia nervosa. I'm not sure why; she certainly met all the diagnostic criteria listed in DSM-IV. Parker-Pope's piece suggests that such criteria tend to be overly inclusive and vague. I don't think that's true for eating disorders--on the contrary. My daughter's psychiatrist-in-training diagnosed depression with secondary EDNOS--eating disorder not specified. I don't know if it made a difference in her treatment, but it did saddle her with a diagnosis that was completely inaccurate. I don't know how that might affect her down the road.

Any doc treating eating disorders should know that depression is a typical presentation when someone is acutely ill with AN, and it usually goes away with weight restoration.

I know from friends who are psychiatrists and M.D.s that it's increasingly tough to steer clear of drug money and influence. Even if you refuse the free dinners and concert tickets and cutesy pens and other freebies, as Parker-Pope points out, much of the research in the U.S. is being paid for by Big Pharma. For those of you think that's all right because, after all, everyone wants the Best Thing, think back a month or two to this report about cholesterol-lowering drugs. Drug companies will in fact behave unethically if the bottom line is at stake.

Personally, I don't want Big Pharma writing the rulebook for psychiatric disorders. I'm just not sure how to stop them.

Apparently you can fool all the people all the time

At least that's the story making the rounds about Dove's "Real Beauty" campaign, which was praised to the skies by many FA bloggers and others. According to this story, those unretouched photos of beautiful-but-not-"perfect" women may actually have been, you know, retouched.

I got a good laugh out of the last line of the story:

If only for the excessive amount of self-righteousness that accompanied the PR effort surrounding this ad campaign, let's sincerely hope these retouching allegations are true.

As one of the commenters points out, the company that owns Dove also owns Slimfast. Corporate hypocrisy, anyone?

The virtues of a high-fat diet

Since fat has been demonized so consistently in the media lately, I thought it was worth reporting this study on the link between diet and seizures.

For children with seizures, eating a diet high in fat and low in carbohydrates can significantly reduce the number of seizures they have. Which, when you think about it, is a fascinating bit of information.

People in recovery from anorexia need a lot of fat in their diets to restore normal brain functioning. Something I told my daughter over and over while she was recovering was that her brain needed fat in order to work properly.

It's true.

Fat karma

This study, reported in the New York times, confirms what some of us have known for years: Fat cells, like other matter, cannot be destroyed. Each adult has a certain number of fat cells, and that number remains constant throughout your life. When it comes to anything to do with metabolism, the body seems to be very efficient at seeking out and maintaining a state of homeostasis.

E.A. Sims' famous Vermont Prison Studies found that prisoners who were fed 75 percent more than normal gained relatively little weight, and quickly returned to their normal weights when their normal eating resumed, we've understood this mechanism. Notice that the word their is highlighted, because, as we know, there is no one weight that's "normal" for everyone.

So it's not surprising to find that the number of fat cells in an adult human remains more or less constant. But you can bet your sweet tooth that corporations--I mean obesity researchers--are going to keep scrambling to find ways to change that magic number.

So far, every effort we've made to futz with metabolism has either been unsuccessful or backfired and created more harm than good. Maybe we'd do well to take a more Buddhist approach: Your fat karma is unalterable, at least in this lifetime.

Deconstructing Self

If you haven't seen Sandy Szwarc's cogent analysis of the much-touted Self magazine eating disorders survey, get thyself over here right away and read it. Sandy's done a brilliant job at unpacking some of the most subtly disturbing elements of this "report" on women and disordered eating and on how it's been received. The cognitive disconnect she highlights refers not just to this particular study and the reactions to it but the disconnect we all experience of living in a society where food and eating and what we look like are bound up with so many judgments and with our most essential feelings about ourselves.

Food for thought indeed.

More scare tactics?

This story from the AP adds yet another entry to the annals of fat and thin. It covers new research that claims to show that fat-but-fit is a figment of the fatties' imagination.

The new study followed some 39,000 women with an average age of 54 over a period of 11 years, tracking their weight, levels of physical activity, and incidence of heart disease. Says the article:

Compared with normal-weight active women, the risk for developing heart disease was 54 percent higher in overweight active women and 87 percent higher in obese active women. By contrast, it was 88 percent higher in overweight inactive women; and 2½ times greater in obese inactive women.

Makes you want to start that diet now, right? But it's important to note that the women in the study were self-reporting their levels of physical activity, and self-reporters tend to overestimate when it comes to things like how much exercise they get. Steven Blair of the University of South Carolina points out that fat people who passed a treadmill fitness test did not face higher mortality from heart disease, a fact that seems to support the self-reporters' loophole.

Despite this study's sensationalized headlines, we still have no idea what is and isn't true when it comes to fatness, fitness, and mortality. But we do know that on the whole, diets don't work; that being physically active is better for your health than being sedentary; and that, as Ellyn Satter has shown time and time again, it's much better to be a competent and joyful eater than to be obsessed, anxious, and fearful around food.

So don't despair when you come across this study and the many news reports about it. Read it in context, understand what it does and doesn't say, and dance as much as you want.

Facebook me

I've finally been dragged into 2.0, not exactly kicking and screaming but certainly clueless. Which is another way to say I've got a Facebook page now and could use some Friends. So if you're out there, look me up, would ya? Maybe we can get a new group going.

Another book the world doesn't need

Spring is here, and I've been feeling mellow. A new book deal is proceeding apace. Life is good. I was beginning to think I'd used up my quotient of outrage for the year.

And then Maggie sent me this.

"This" is a book written by a plastic surgeon, aimed at kids to explain their mothers' plastic surgery.

As you can see from the sample panel I've included, it's worthy of outrage on many counts, including lousy illustrations and self-serving, poorly written text. Amazingly (or not), it's gotten quite a bit of national press, much of it rather positive.

I'm giving it two thumbs down. I only wish I had more than two hands.

Penny wise, pound foolish

That truism can apply to so many corporate decisions, can't it? But when it comes to treating eating disorders, the truism becomes both literal and deadly.

Take the case of this Connecticut family, fighting for their insurance company to do the right thing and cover treatment of their 17-year-old daughter's anorexia. While insurance covered her previous treatment, her last admission was kicked out because of a treatment delay that triggered a "within 3 days" rule.

In fact, treatment delays are common and are usually--as in this case--the result of a shortage of beds or space in treatment programs. There's nothing a family can do to prevent them. To have coverage denied because of such a delay--a delay that can be lethal to the adolescent being treated--is both cruel and immoral.

Readers of this blog know how I feel about the health insurance industry: Any industry that profits from people's pain and suffering should be abolished. Until that day, the industry should be held accountable for decisions like this one, which risk lives and add suffering for families already dealing with the torments of an eating disorder.

The girl in question said it best: "If someone needs help, give it to them. Because people don't ask for help if they don't need it. Trust me."

This is especially poignant given the fact that so many people with anorexia cannot recognize that they're ill or ask for help.

Our former insurance company denied coverage for much of my daughter's treatment because we live in a state without mental health parity. (One more reason why I can't wait to move back to New York.) As we know, there are people whose entire work life consists of looking for reasons to deny people coverage. How do they sleep at night?

I hope folks from the company in question read this. And I hope they do the right thing. For once.

Race and place (off-topic)

So after 16 years of living in the midwest--a place I hated passionately for at least the first 6 or 7--I've come to appreciate some of its finer points. Like the access to nature. The relative cleanliness of my small city. The neighborly feeling on our block and on many blocks.

I'm actually going to miss all that when we head east to Orange Country this summer. But there are things I won't miss, like the totally whitebread nature of our small city.

We bought a house this weekend (a house!) in the university neighborhood, which, unlike the one in this small midwestern city, is gritty and urban and integrated. I remember when we moved here from Manhattan's Lower East Side. I remember thinking, Where are all the African American people? They're here, of course, but there's not much integration here. People divide along race and class lines. I don't think I've made a single black friend since moving to the Midwest.

On our new block, on a chilly Saturday afternoon, we saw two kids on bikes. One was learning to ride. The other was running along beside her friend, holding on. Both were black. Both were adorable. A few minutes later we were able to meet one of the families on the street, a white couple in their late 50s with two soon-to-be-adopted African American daughters, former foster children. They were friendly-ish, and I'm looking forward to getting to know their family better.

Right now, our move seems scary and ridiculous. I mean, why change everything when we're relatively comfortable? So what if I don't love my job? How do I know I'll like the new one any better?**

But another part of me looks forward to adventure and change and challenge. Or at least it will when I can shake this damn midwestern flu we've all had going for weeks now.

Our new house has no fireplace (even though we've hardly used ours I like having it) and very little yard, but it does have a pantry, which will be lovely once we've gutted and redone the kitchen, redone the roof, stripped the godawful paint off the woodwork, installed full-size toilets (for some reason the previous occupants put in teeny-tiny toilets; maybe they all had teeny-tiny tushies), redone the attic, propped up the carriage house in the backyard (which Mr. Professor is thrilled to have), and a few other things.

I'm going to grow some things in pots this year in the front yard. Next year we'll figure out how to put in some raised beds somewhere. I'm a rotten gardener but I love picking veggies out of the backyard.

There's a metaphor in here somewhere, but I'm too congested to figure it out.



**The boss thing I already know is better. My new department chair is fabulous--warm, friendly, outgoing, funny.

For readers in the U.K. . . .

Maybe you've already heard about Scarlet Magazine's campaign to ban fat jokes on TV. As editor in chief Sarah Hedley puts it:

Ordinarily, I’m a big fan of Alan Carr, but I only got as far as the second episode of his new Channel 4 show Celebrity Ding Dong before I began to feel uncomfortablewith the format. Pitting celebs against ‘civilians’, as we’re referred to on the show, is one thing, but having a laugh at the expense of the morbidly obese is quite another. Sadly this is what viewers were expected to do in episode two when Davina McCall and team were asked which was bigger, Posh Spice’s waist or obese civilian Tracey’s arm. The celebrity team hazarded a guess, then Tracey was brought on set and measured to prove just how big she was, while the world was invited to point and laugh.

She then goes on to compare obesity to cancer, unfortunately. Still you have an opportunity to sign a digital petition on the subject if you like.

Makes you wish for the good old days of Benny Hill, now, don't it? :-)

Wow

What an outpouring in response to yesterday's Times piece. I had no idea so many people had gone through the same kind of experience. I heard from many, many parents who had nearly lost a child through illness or accident, and from a few who went through the same set of feelings around a parent or sibling.

So I just wanted to say thanks to everyone who wrote and shared a bit of their story with me. You reminded why it is, exactly, that I am a writer. Writing makes me feel not so alone--and I hope it does the same for some of you.

New piece in the New York Times

Here's the linky. Enjoy. And let me know what you think.

Thank you, Canberra Times

for publishing this opinion piece about the connection between anti-obesity hysteria (my word, not theirs) and eating disorders.

Thank you for pointing out the real and tragic human anguish behind eating disorders. Thank you for daring to question the tactics, if not the content, of campaigns against fat.

And thank you for this last line:

. . . let us not forget to protect the innocence and confidence of a child's innate self-image.

Amen.

Recovering from anorexia: a parent's journey

I've come to realize that this is the year I'm recovering from our family's struggle with anorexia. It's been just about three years since my daughter Kitty got sick. She's been physically healthy for nearly two years, and mentally healthy for almost that long. She's happy, engaged in the world, healthy in every measure. For her, anorexia is thankfully in the past.

For me, though, it still feels very present. It took me a while to realize this because things are so positive.

It's little things that trigger the feelings for me right now. Things like the image above, which appeared in our local paper recently as part of an article about a student art show at the university here. It's called "The Fruit Eaters," by student Aniela Sobienski, and looking at it puts me right back in the land of anorexia.

Another trigger: Last night we went to see the movie Miss Pettigrew Lives for the Day. Great movie, about a proper middle-aged woman who finds herself in unusual circumstances. (Go see it. It's worth it.) Every time the main character tries to eat something it escapes her--it falls on the ground, someone knocks the food out of her hand, etc. In one scene she's having a facial; the attendant puts two slices of cucumber on her eyes and walks out. Closeup to her face, which is covered in goo that makes it look bizarre and distorted. Miss Pettigrew looks around and then eats the two cucumber slices. The look on her face is positively blissful.

Me? I was right back in anorexia land.

Maybe some of this reaction is because I am writing the book about our family's experience that I've been wanting to write for a while. It's a useful catharsis for me and, I hope, useful for others.

I can't imagine what this process of recovery is like for parents who have been pushed out of their child's recovery. Who have been the victims of "parentectomy." I am so grateful that we went the route we did in helping our daughter through anorexia.

Can eating disorders be prevented?

Laura Eickman thinks so. She's a Psy.D. with a private practice in Kansas who makes presentations on what she calls the danger zone, which she defines as the area between eating disorders and "healthy" behaviors. (Which, by my reckoning, is everything else. But I digress.)

Eickman gave a talk recently at Pittsburg State University, a fact that caught my eye because of her emphasis on prevention. The question of whether prevention efforts are effective is a controversial one; some say that few to none show any tangible results, while others see value in certain kinds of interventions.

It's a question that weigh heavily on my mind. Could my daughter's anorexia have been prevented? Her younger sister is at greater risk of developing an eating disorder now; what, if anything, can be done to prevent it?

I don't think Eickman has any answers, at least not judging from the news articles about her presentations. (I haven't seen them myself.)

This quote, from Collegionline, the PSU student independent online paper, disturbed me greatly:

Eickman says people in the danger zone take only one to two years to treat, while those with fully developed disorders take five to six years.

As I have reason to know, at least the last half of that sentence is a lie. My daughter was weight restored from severe anorexia in 11 months; her mental recovery took another 6 months or so. Today, about 3 years after she developed anorexia, she is healthy and happy, with a positive relationship to eating, food, and her body, thanks to the fact that we used family-based treatment to help her recover.

Maybe it's PTSD on my part, but I don't trust "experts" who make statements like the one attributed to Eickman. And somehow I suspect her so-called prevention program is little more than words.

Which is too bad. Because God knows we need prevention that works.

Feminism and the pressure to be thin

Celtic Chimp posted this comment on another thread, and it inspired me to write a new post:


I have never understood how women can have such a wrong impression of themselves. Healthy, beautiful women obsessing about their weight. If women could just see themselves from a blokes perspective for five minutes they would be very confident! I and most men I know find very thin women to be extremey unattractive. Now I'm not saying it is all about what men want or that that is why you lot do the whole weight thing but it is most perplexing to us men-folk. Whilst I agree that aiming that sort of complete bollox at young girls is completely irresponsible, I do think that adult women have got to take some responsibility and teach girls a little common sense. Maybe when their mothers stop fretting about their weight and image so much they will follow suit.

Well, Celtic Chimp, here's the thing: The pressure to be thin is not about what men want. It's not about sexual attractiveness. It's about power.

As you point out, many men--maybe most men, I don't know, as I'm not a man--do not find extreme skinniness sexually attractive. So the thin-is-sexier argument doesn't wash. Most men I know want women to look like women, not prepubescent boys.

No, this is about power. It's about wanting women to be small in the world, to take us less space, literally and metaphorically. This of course is not a new idea; it's one of the underpinnings of first wave feminism, and sadly it still holds true.

I think there's something else going on here, too. I think so long as women are obsessed with our weight and eating and body image, we aren't focusing on other, much more important things. Anyone who's ever had an eating disorder can tell you that while you're in the grip of one, you have no energy or concentration or ability to frocus on anything else. An eating disorder is a kind of closed loop. A dead end. Something to keep the circuits busy so they don't go exploring.

I think the cultural norms today around women and food and eating amount to an eating disorder, or at least highly disordered eating. Women's "place" used to be in the home; that was the 19th-century way to keep women down. Now, maybe, dieting and exercising and obsessing over weight is taking on that role.

Either way, the result is the same. So long as we're busy weighing ourselves, we will never measure up and never get any bloody real work done in the world. In that sense I think you're right: We, women, have to stand up to the culture, reject the pressure to be thin, protect our children from it.

It's not easy to swim against the current. But it's necessary.

So thanks for making the point. I'd love to hear what my readers think.

You tell 'em, Daniel Engber

In this article from the Dallas Morning News, Engber deconstructs a couple of the myths of the obesity "crisis." Nothing particularly new, but nice to see it in a big paper/national format.

When were you born?

I stumbled on this via Laura over at Eating With Your Anorexic, and expected it to be kinda silly.

To my surprise, some of it holds true for our family:

I have panic disorder; I was born in October.
My husband has dyslexia; he was born in July.
My younger daughter also has panic disorder, but she was born in July.
My older daughter had anorexia; she was born in February.

I have no idea what it means, though these people have attempted to make sense of it. Is this soothsayer science or is there some truth in here?

It's interesting to think about, either way.