Eat to enjoy, not to lose weight

This article in the New York Times may seem a bit redundant to some, but I'm encouraged to see it in the venerable Gray Lady herself. It saddens me a bit that the notion of eating for pleasure rather than weight loss is such a novelty, but there it is. At least it's out there.

David Foster Wallace, 1962-2008

My closest encounter with the writer David Foster Wallace, who committed suicide last week, came when I was working as an assistant in a small literary agency. One of my jobs was to read the slush pile, the manuscripts sent in cold by hopeful writers looking for an an agent. One of the manuscripts that came across my desk was a draft of what later became Wallace's first published book, The Broom of the System. It was brilliant, entertaining, dazzling, and I wanted to take Wallace on as a client. My boss said no. "He'll never be a commercial writer," he said scornfully, and that was that.

He was wrong, of course, about that and many other things. Wallace went on to become not only critically acclaimed but to achieve some measure of commercial success. He was an original, one-of-a-kind, a writer of immense talent and heart. From the oustide, his life looked golden in every way.

He was also, we know now, severely depressed for much of his life. His struggle with depression came to an end last week when he committed suicide. And therein lies my point. It is impossible to know, from the outside, what anyone else's interior life is really like. That works both ways: The perfect-looking life may be a living hell, and the seemingly diminished life may be rich and full in ways outsiders can't imagine.

I bring this up not only because I'm mourning a writer of grace and heart; I bring it up in this blog because eating disorders, like depression, often present a golden exterior. The life of someone with an ED can look wonderful, perfect, fulfilling to an observer. Yet the person who struggles, every day, every minute, with anorexia or bulimia or ED-NOS, may be smiling through torment.

When I read about Wallace's death, I couldn't help thinking about how many people with anorexia wind up committing suicide as well. And I mourn them too--the lives that could have, should have gone a different way.

I mourn the misfire of chemicals in the brain that causes severe depression, anxiety, eating disorders. And I look forward to the day when we will know more and be able to help more.

In the meantime, go out and read one of Wallace's works, and remember this talented and tormented man.

No evidence-based treatment for anorexia?

According to this study, which is an overview of 40 years of eating disorders treatments, there are still no evidence-based treatments for anorexia nervosa. "A specific form of family therapy (based on the Maudsley model) appears promising," write the study's authors.

Appears promising? Actually, FBT, or the Maudsley approach, has been shown to be successful (85 to 90 percent long-term recovery rates) for treating both anorexia and bulimia. In the last 10 years there have been several good studies on FBT, including this one, this one, and this one.

And yet some of the top researchers in the field are still saying that there is no evidence-based treatment for anorexia, and that the Maudsley approach "appears promising." Which is rather like saying that there appears to be a link between smoking and lung cancer.

After 40 years with no other good treatments, you'd think researchers would jump on this one. So why the damning with faint praise?

Come on, you guys. You're the ones who can get the word out to parents best. You have a moral obligation to spread the word about FBT--the ONLY evidence-based treatment we've got at the moment for treating anorexia. I'll be thrilled if we turn up more treatments that are effective. In the meantime, though, let's use what we've got.

Take a survey, help eating-related research

The invitation below comes from a graduate student at the University of Maryland. Please correspond directly with her if you have questions. Take the survey and help add to what we know about eating.

--HB

TO ALL WHO WROTE IN: The link has been fixed now. Thanks for letting me know!

TAKE A SURVEY

Do you love food? Can you often “out-eat” most of your friends? If the answer to either of these questions is “yes,” you may be a great candidate to take my survey.

My name is Colleen Schreyer, and I am a grad student at the University of Maryland, Baltimore County. I am doing my master’s thesis on individuals who are able to eat a lot of food, and genuinely enjoy eating. I am also looking at individuals who are able to eat a lot of food, and perhaps don’t feel so good about it. I have an online survey that takes approximately 30 minutes to complete. All participants are entered in a drawing to win an Apple Ipod. Your answers are completely confidential, and I have approval from my university to conduct this research. If you would be willing to check out the survey, please click on thIS link. All and any help is greatly appreciated. If you have any questions, please email me- colleen2@umbc.edu. Thanks so much for your time!

An open letter to all diet food peddlers

Due to the recent avalanche of PR-type emails to my inbox, I feel compelled to write this letter.

If you do PR for a diet-related product, please do not send me emails offering to send me samples and hoping I'll review it on my blog.

Don't send me perky emails about 100-calorie foods that will fill you up all day, packed full of unparalleled nutrients. (Really! Who dreams this crap up?) Don't think I'll shill for you. I won't. If I write about your diet product, rest assured I will tear it apart. That kind of publicity you really don't want.

This blog is NOT diet friendly. To paraphrase my late friend Mimi Orner, we are anti-diet, anti-anorexia, anti-bulimia, anti-healthy eating fascism, and anti-eating disorder here. I am not your friend. My readers are not your potential customers.

This blog is a diet-free zone. Go peddle your crap somewhere else.

Support group for parents: Madison, Wisconsin

The next meeting of the Madison, Wisconsin, parent support group will take place on Tuesday, Sept. 23, at 7:30 p.m. at Starbucks, 3515 University Avenue. This group is parent run and offers support, practical advice, encouragement, and hope for parents whose children are struggling with eating disorders, with a special emphasis on Family-Based Treatment (also known as the Maudsley approach).

For more information, contact Denise Reimer, reimer1@charter.net.

And if you'd like me to post a parent support group in your area, please email me off the blog at hnbrown at tee dee ess dot net.

Naturally fat?

This comment, made in response to an earlier post, seems to epitomize so much of the anti-obesity attitude that I thought it deserved its own post:

Of course there's nothing wrong with being fat. I don't get why fat people get offended when we say that obesity is dangerous. We're not talking about people who are fat. We're talking about people who are dangerously obese. You remind me of the naturally skinny girls who get offended when people speak out against anorexia nervosa and complain, "Why does everyone hate skinny people? Wah!"

There is absolutely nothing wrong with being naturally fat or naturally skinny. But if someone is deathly thin or morbidly obese then it is a real problem.

So first of all, please tell us how to distinguish between "naturally fat" and "morbidly obese." What is "naturally fat"? Is it the-amount-of-fat-I would-have-had-if-I'd-never-gone-on-a-diet? Is it 5 pounds "overweight"? 20? 50? Is it the same for you as it is for me? Is it fat that comes from eating avocados and almonds as opposed to chocolate cake and ice cream? Who decides what constitutes natural fat vs. unnatural fat?

I'm fascinated by the semantics around this issue. Morbidly obese = morbidity = a death sentence if you're fat. When's the last time you heard anyone called "morbidly skinny"? And yet semi-starvation can certainly kill you.

Personally I don't know any "naturally skinny girls who get offended when people speak out against anorexia nervosa." Someone who is thin but not eating disordered typically wouldn't be offended by this. Someone who's eating disordered, either diagnosed or subclinically, might well be offended because the nature of anorexia is to be ego-syntonic. They identify the illness with themselves and will defend it to the death--their own. They can't help it; it's a symptom of the disease.

I hope my readers will weigh in (so to speak) on this one. I'd like to know what you think.

Fat-free picnic

My younger daughter and I just came from an all-school picnic at her new school. She's starting 8th grade on Monday. The picnic was massive--800 people milling around the school grounds on a humid, muggy night. It wasn't the kind of event where you meet and really get to talk to people, and that was OK.

What wasn't OK was the food. Oh, it tasted all right, but I noticed there was nary a speck of fat or sugar at the picnic. There were flame-grilled veggie burgers, grilled chicken breasts, and I believe some kind of hot dog (I don't eat meat, so I didn't notice). There was pasta salad in a vinaigrette that was all vinegar. There were grilled veggies, which were very tasty. There was a huge bowl of salad with an array of dressings, every one of which was fat-free. I asked one of the caterers if there was any salad dressing with oil in it, and she said, "Honey, they specifically told us to bring only fat-free dressings."

For dessert there were trays of watermelon, which happens to be the one fruit I dislike.

I just hope this isn't a sign of things to come.

Are you a woman in your 20s or 30s? Read this

This opinion piece is not on the topic of food or eating, but this is a crucial and compelling subject, and one that every woman (and man) in America today should read. Especially those of you who think feminism was what your parents and grandparents did, and you're the new post-feminist generation. :-) There is still work to be done, my friends.

Suffer the little children

The latest "SmartSummary" from our much-hated health insurer arrived in the mail yesterday. I'm sure one reason our premiums are so high is that they periodically generate an 8-page booklet for each member of the family, replete with all sorts of useless information.

The piece that really burned my boat was this page, which arrived only with my 8th-grader's package. Let's take a minute to deconstruct this noxious document, shall we?

First, take note of the underlying threatening tone of the introduction. In case you can't read the scan, here it is:

Before you go back to school, take a minute to think about how sitting in class means you'll need more time for physical activity outside of school to stay healthy. Use this Body Mass Index (BMI) to figure out if you're in a healthy weight range, then you can see how to burn more calories and eat healthier in a way that fits your lifestyle.

Ths little gem offends on a variety of criteria, starting with the grammatical and syntactical errors (comma splice, word repetition, and excess verbiage). It then moves on to emotinal blackmail. Sitting in class leads to not staying healthy, unless you add more physical activity. There's a not-so-implicit threat here: You've got to burn off every minute you spend sitting on your tush and studying, kids.

For a kid like my older daughter, who likes to play by the rules and do everything "right," this notion could be enough to trigger a lifelong eating disorder, not to mention a fear of school and studying. And who's to say that each kid isn't already plenty physically active? The summary assumes that kids aren't getting enough exercise. Maybe they are, maybe they aren't. But this piece of paper sure as hell doesn't know.

Moving down the page, notice the list titled "Burn the Calories." One of the most egregious ideas behind the whole "wellness" movement is the idea that you can quantify and generalize in this way. Whereas anyone with a whiff of education on the subject knows that this depends not only on the size and age of the person in question but on his/her particular metabolism. Yet this paper confidently announces that a half hour of soccer burns 238 calories. Bullshit.

The eating disorder triggers continue on the bottom left of the page, where my daughter is told that 1 small cheeseburger would take 29 minutes of jogging to "burn off." There's a lot wrong here, starting with the idea that every bite you take must be "burned off." That's like saying every gallon gas you put into your car must be used immediately. Then there's the implicit idea that the foods listed here--plain "donut" (sic), cheeseburger, piece of pie, fried chicken sandwich--are bad for you and must be routed from your system asap.

Finally there's the ubiquitous BMI calculator and BMI chart. Once more with feeling: The idea of "ranges" is beside the point, especially for growing children. What's healthy for one child at one point in her life will not be the same as what's healthy for another child, or for the same child six months later.

I call this Bullshit 101. And I'm ever so glad my hard-earned money will no longer be going toward creating such appalling crap.

Off-topic: Need a laugh?

These came to me from my dear husband, who got them another blog, and I just couldn't resist.

Here are the top nine comments made by NBC sports commentators so far during the Summer Olympics that they would like to take back:

1. Weightlifting commentator: 'This is Gregorieva from Bulgaria. I saw her snatch this morning during her warm up and it was amazing.'
2. Dressage commentator: 'This is really a lovely horse and I speak from personal experience since I once mounted her mother.'
3. Paul Hamm, gymnast: 'I owe a lot to my parents, especially my mother and father.'
4. Boxing analyst: 'Sure there have been injuries, and even some deaths in boxing, but none of them really that serious.'
5. Softball announcer: 'If history repeats itself, I should think we can expect the same thing again.'
6. Basketball analyst: 'He dribbles a lot and the opposition doesn't like it. In fact you can see it all over their faces.'
7. At the rowing medal ceremony: 'Ah, isn't that nice, the wife of the IOC president is hugging the cox of the British crew.'
8. Soccer commentator: 'Julian Dicks is everywhere. It's like they've got eleven Dicks on the field.'
9. Tennis commentator: 'One of the reasons Andy is playing so well is that, before the final round, his wife takes out his balls and kisses them... Oh my God, what have I just said?'

It stands to reason

that if your knees have deteriorated enough to limit your mobility, you are less able to exercise. But that little piece of common sense hasn't stopped the British health care system, which refuses knee replacements to Britons who are considered "clinically obese"--with BMIs of over 30.

Now a study from the University of Southampton demonstrates that yes, Virginia, fat people benefit from knee replacements, too.

Just for a little context: My BMI is 30.9. I am a physically active person who bikes or walks to work (3 miles), runs up stairs, bikes 8 or 10 miles for fun, and loves to go dancing. If I needed a new knee, I would be one pissed-off person if I was told I was too fat to get one.

For once, common sense may prevail. Though let's see if the NHS changes its policies before we celebrate.

Join the fray . . .

over at BusinessWeek, where there's a somewhat spurious debate going on over whether the media causes eating disorders. Normally I try to stay away from arguments like this, but because it's BusinessWeek, a fairly respectable publication, I think it's worth it to put the point across. Be warned: There are some real trolls commenting over there, so don't visit if you're feeling fragile.

We're getting there. . . .

And I know this from reading pieces like this in the New York Times. Turns out your performance on a treadmill test is a far better measure of your mortality risks than the numbers on a scale. We told you so!

So yes, it's better to be fat and fit than skinny and unfit. And yes, let's take a look at just how loaded words like fat and overweight are in our culture.

I can't wait for this kind of thinking to percolate down through the culture. Just last night I was at dinner with, among others, a woman who teaches others about exercise and fitness. She paid lip service to some of the "fat but fit" thinking, but her parting comment was so typical of this debate: "But it's still bad to be fat."

I'm sending her the link to this article. Hope she gets it.

Book review: Why She Feels Fat

If you pick up Why She Feels Fat, by Johanna Marie McShane and Tony Paulson, because you want to understand the inner life of someone with anorexia, bulimia, or binge eating disorder, you'll be sadly disappointed. Actually I think you'll be disappointed no matter why you pick it up. There are dozens of books exactly like this already in print. The world certainly doesn’t need another one.

I expected to read an insightful exploration into the biology and psychology of eating disorders. I expected to find an answer to the question posed by the title. Why do people with anorexia and bulimia feel fat even when they’re not? The phenomenon has been well documented; Walt Kaye tells the story of bringing two 70-pound anorexic women into a class of med students and asking them to describe each other. Each sees the other as way too thin, gaunt and unattractive. Each sees herself as way too fat. This is a fascinating demonstration of distorted brain chemistry at work.

But these aren’t the kinds of questions the authors take on. Their answers to the question posed in the title are the same old same old we’ve been hearing for many years now about eating disorders: She feels fat because she was sexually abused, because her parents divorced, because her mother is overly critical and her father is absent. She starves, binges, and/or purges because—wait for this groundbreaking revelation—it’s a way to control a disappointing or painful world.

There's nothing about biology, genetics, or any of the new research on eating disorders that is changing the way we understand and treat them.

There's nothing new about the so-called insights offered by this book: They're all the rationalizations and delusions of eating disorders, offered up without analysis or true understanding. When my daughter was ill with anorexia, I heard them all. The difference is that I didn't take them at face value. These authors appear to do just that.

The section on treatment is just as outdated and even harmful. "The job of the therapist is to help your loved one understand, acknowledge, and resolve the issues that are fueling her illness," write the authors. In the meantime, if your loved one starves to death, or has a heart attack, well, never mind. At least they'll get to the bottom of the problem.

The job of the therapist is not to answer the question why. It's to heal the eating disorder.

If the authors were up on the latest research on treating eating disorders, they wouldn't write, as they do, "Medication may be necessary either for the short term to facilitate treatment or for the long run to achieve emotional balance." While there are n o doubt people for whom medication is helpful, none of the big studies have shown any reason for routinely prescribing meds like Prozac and Paxil for those with eating disorders. This is not only wrong-headed advice--it's one size fits all advice.

The authors also recommend working with a dietitian or nutritionist--again, standard advice for someone with an e.d. They continue down the conventional path by recommending that the nutritionist and patient develop an eating plan together. This might be good advice for treating bulimia, but it's definitely not good advice for treating anorexia. And that's another of the problems with this book: The authors don't differentiate among the eating disorders.

I could go on, but you get the idea. No stars for this book.

Eating disorders workshops in central New York

The Mental Health Association of Onondaga County is offering a two-part Parent Partner Workshop, held on September 9 and 16th in Syracuse, NY. These three-hour workshops are designed to help families and loved ones support people with eating disorders, and I hope if you're in central NY you'll try to make one of the workshops. I'm thrilled that I've been asked to speak on the 16th. If you attend, please come say hello. I'll be talking about our family's experience with anorexia and about Maudsley Parents.

And the best part is that snacks are provided!

Details:
Sept. 9 & 16
6-9 p.m.
Cornell Cooperative Extension, 220 Herald Place, 2nd Floor, Syracuse
$10.00 per person, $30.00 for family of 4

Follow-up on A.

I emailed A. and heard back from her--a great email. She knows exactly what she's dealing with, with our family, and seems to have a pretty good handle on it.

And it seems that we can develop a relationship. I'm very glad.

Eating disorder studies

Hello all,

Here's your periodic roundup of research opportunities available in the e.d. world. We all know there is woefully little research on e.d.s--here's your chance to help make a difference. And maybe get some top-of-the-line free treatment.

Research Studies on Eating Disorders:

Clinics and Hospitals Team up to Study Eating Disorders: Six North American sites are teaming up to evaluate outpatient treatments for adolescents with anorexia nervosa. To date, this is the largest National Institute of Mental Health-funded anorexia nervosa treatment study. The study will allow for a thorough evaluation of two types of family therapy and will also test whether FDA approved antidepressant medication can enhance and prolong the result. The goal of the study is to improve recovery rates.

"Males and females ages 12 through 18 are the target population, because it is essential to identify and treat the illness in its early stage," says Craig Johnson, Ph.D., director and founder of Laureate Eating Disorders Program. He says that a parent may suspect anorexia nervosa if they have an underweight child that worries about their weight and appears to avoid food obsessively. Dr. Johnson and Ovidio Bermudez, M.D., internationally known eating disorder experts, are the principal investigators at Laureate for this study of two forms of outpatient family therapy. The treatments prescribed in the study, have been tested and shown to be helpful with patients in previous studies at Stanford University School of Medicine and The University of Chicago Hospitals.

After undergoing a screening process, families who qualify will be randomly assigned to one of four treatment combinations. The study is comprised of 16 one-hour family therapy sessions delivered over a nine-month time period and a medication (either fluoxetine or placebo) delivered over 15 months under close medical supervision. The family therapy sessions, medications and medication monitoring are all paid for by the NIMH grant.

This international eating disorders study is being coordinated by Stanford University, and includes six recruitment sites: University of California San Diego, Washington University School of Medicine in Saint Louis, Cornell Medical College, Toronto General Hospital, Sheppard Pratt Health System in Baltimore and Laureate Psychiatric Clinic and Hospital.

Individuals who suspect they might have anorexia nervosa, family members who believe their child may have the illness and physicians of potential patients are urged to call Nancy Morales, RN at 918-491-3722 to learn more about the study and/or apply for participation.



San Diego, CA: UCSD Researchers Seek Males and Females with Anorexia Nervosa: The UCSD researchers are currently seeking adolescents and adults currently suffering from Anorexia Nervosa to participate in one of their three current studies. To qualify for any of the studies one must be at least 15% below ideal body weight and be fearful of weight gain, despite being underweight. Both adults and adolescents between the ages of 14-45 are needed to participate in a taste study and would be compensated for up to $70 for completing the assessments, taste tests and interview. Adults 18 years of age and older are needed to participate in a randomized control trial of the medication Quetiapine, in which they will receive either the study medication or a placebo. Subjects will be compensated up to $360 for completing study related assessments and the medication treatment. In addition, they are offering several months of family therapy treatment for families with adolescents between the ages of 12 and 18 at no cost. The adolescents in this study will also be randomly assigned to receive either the medication Fluoxetine or a placebo. For more information, contact UCSD Eating Disorder Treatment and Research Program at 858-366-2525 or email edresearch@ucsd.edu.



San Diego, CA: UCSD Researchers Seek Women Recovered From an Eating Disorder: Help UCSD researchers understand what causes eating disorders. They are seeking female participants between 18 and 45 years of age who are recovered from Anorexia or Bulimia Nervosa. By participating in the study, subjects will be assisting physicians and researchers in developing new treatments for these complex and serious disorders. Subjects will be compensated for your participation in this study. For more information contact the UCSD Eating Disorder Research and Treatment Program at 858-366-2525 or email edresearch@ucsd.edu.



Massachusetts Research Study - Massachusetts General Hospital Study of Therapy for Bone Loss in Anorexia Nervosa: The Neuroendocrine Unit of Massachusetts General Hospital is conducting research studies on anorexia-induced bone loss. Their screening study is for men and women age 12-50 with anorexia nervosa. They are investigating causes of osteopenia (or bone loss) in the spine, hip, wrist and total body. The study involves one visit of approximately 3 hours. Their treatment study is for women aged 18-45 with anorexia nervosa and absent or irregular menstrual periods. They are investigating the combined use of a natural hormone and a medication that is effective for bone loss in postmenopausal women as a novel treatment for the bone loss seen in women with anorexia nervosa. They hope that the combination of these two investigational medications will help rebuild depleted bone and prevent further bone breakdown in women with anorexia nervosa. The study consists of 6 visits over 12 months. A stipend of up to $675 is awarded throughout the course of the study. If interested, call Erinne Meenaghan, N.P. at 617-724-7393 or email nedresearchstudies@partners.org.



Massachusetts: Bulimia Nervosa Study: Free confidential treatment is available to those who are eligible. Do you or someone you know binge eat? Do you or someone you know compensate by vomiting or other extremes? Do you or someone you know have severe moodiness or relationship problems? Researchers are now enrolling participants (ages 18-65) in a free treatment study investigating two active treatments, including education and counseling, for bulimia nervosa. If interested call 617-353-9610 or visit here.



New York, NY: NIMH-funded, IRB-Approved Study of Adolescents with Bulimia Nervosa (ages 12 - 21 years). This study takes place at NYSPI/Columbia University and compensation is provided for participation ($100). For more information, contact Laura Berner at 212-543-5316. P.I.: Rachel Marsh, Ph.D., Assistant Professor of Clinical Psychology, Columbia University/ New York State Psychiatric Institute, phone 212-543-5384, email marshr@childpsych.columbia.edu.



New York, NY: The National Institute of Mental Health is sponsoring a multi-center international study to compare two types of family therapy as well as fluoxetine or placebo (an inactive medication) in the treatment of adolescents with anorexia nervosa. They are looking for families with an adolescent with anorexia nervosa between the ages of 12-18 years. Participation involves completing assessment interviews, questionnaires, and engaging in 16 family therapy sessions over the course of nine months with medication continuing for another six months. The study is being held at the Eating Disorders Research Program, The Westchester Division of New York-Presbyterian Hospital, Weill Medical College of Cornell University. Contact the Research Coordinator, Samantha Berthod, MA at 914-997-4395.



Pittsburgh PA. Seeking Women Recovered from Anorexia or Bulimia Nervosa. Dr. Walter Kaye and his research team at the Eating Disorders Research Program at the University Pittsburgh Medical Center are looking for women who have recovered from anorexia or bulimia nervosa for a research study on brain chemistry in eating disorders. Study participants must be between 18 and 45 years old, medication free (birth control pills acceptable) and not pregnant or nursing. The study involves phone interviews, questionnaires, PET and MRI scans, lab work, physical exam, two visits to Pittsburgh and 8 weeks of fluoxetine (generic form of Prozac). (Note: All expenses incurred during the study, e.g. travel expenses, lab work, physical exam and etc. are paid for by the study.) In addition, eligible participants will be compensated up to $1300 upon completion of the study. For more information, email EDResearch@upmc.edu or Dr. Kathy Plotnicov at plotnicovkh@upmc.edu or Dr. Sharon Barnes at barnessd@upmc.edu. Interested parties can also call toll-free at 1-866-265-9289 or submit a contact form online here.

"She's as big as a house!"

I spent last weekend at a reunion of my extended family. I've spent very little time with my family over the last 20 years. Many of my aunts, uncles, and cousins still live in the same little square of suburban south Jersey where I grew up. I moved away at 16 and never lived in the vicinity again.

And since my grandparents died--my grandmother 18 years ago, my grandfather 5 years ago--I haven't seen the extended family very often. We get together at funerals and weddings, and that's about it. Last weekend my aunt and a cousin planned a reunion of the very large extended family, so it was the first time in a while I saw many of the relatives I grew up with.

For the most part the weekend was wonderful--except for the fat talk. I knew there would be fat talk; there always is, with my family, most of whom are not fat, all of whom are very conscious about fat.

Among other things we created an epidemiological chart showing diseases in the family. Everyone was encouraged to list those that affected them. I wrote "eating disorders" and "anxiety" on the chart. My cousin L. happened to be standing nearby when I'd finished. L. has been fat for much of her life--anywhere from 20 to 120 pounds overweight. She's extremely judgmental about weight (most of all of her own, of course) and brings up the subject often.

L. has two daughters, both grown now. One of her daughters had bulimia as a teenager, or so I thought. I've always liked my cousin A. a lot, and was sorry she wasn't at the reunion. I turned to cousin L and asked, "A. had bulimia, right? How's she doing now?" (Cousin L. knows about my daughter Kitty's anorexia.)

Cousin L. (angrily): She said she had bulimia, but I never saw any evidence of it, and I'm a clean freak. I think I would have seen it.

Me: Why would she say she had it if she didn't? And didn't she end up in the hospital with a burned esophagus at one point?

Cousin L.: Well, all I can tell you is that she's big as a house right now. Big as a house.

Me: (just looking at her, saying nothing)

Cousin L.: It's a shanda the way she's let herself go. I've lost a lot of weight recently, and so has J. (her other daughter). Doesn't she look great?

Me: I wish A. had come to the reunion. I'd like to see her.

Cousin L.: (walking away) Big as a house. It's terrible.

This conversation pretty much embodies my family's attitudes toward eating disorders and weight--and, I daresay, the attitudes of many. Eating disorder, shmeating disorder, right? We don't take that stuff seriously. It's all a put-on, a game, a manipulation. But fat--now that we take seriously. Being fat is a crime. You shouldn't leave your house if you're too fat. You wouldn't want anyone else to see you.

And that's why I live a thousand miles away from my extended family. And always will.

OT: Bat mitzvah follow-up

I couldn't resist linking to this delightful blog, written and illustrated by a woman who attended my younger daughter's bat mitzvah a few weeks ago as a visitor to our community.

It's an unexpected perspective on not only my daughter's bat mitzvah but on being Jewish in America. And it's so much fun to read and look at. Enjoy!