Say What?

This poll from CBS has to be one of the weirdest things I've read in a while. It reminds me of the kind of question you'd ask at an 8th-grade sleepover: Which is worse, burning to death or freezing?

I point it out because one of the questions asks,, "What's worse, being obese or suffering from anorexia nervosa?" Take a guess how "people on the street" responded. The pollsters go on to explain that 20 percent of anorexics die from the disease, whereas a 25-year-old obese woman has only a .01 percent chance of dying.

Other questions included comparisons between smoking pot and cigarettes, between having a swimming pool and a loaded gun, and between being married and miserable or single and happy. Each time there was a "counterintuitive" answer. People were apparently surprised to learn that anorexia is deadlier than obesity, that having a swimming pool is more dangerous to your family than keeping a loaded gun, and so on.

Weird, but maybe useful.

The "obesity tax"

I thought about posting on this a few days ago, when Governor Paterson first proposed a tax on non-diet soda, and decided that other folks had tackled it ably, so no need.

Tonight, as I was listening to yet another commentator go at this issue on NPR, I thought about my friend P., who became diabetic a couple of years ago, stopped eating sugar altogether, lost 30 pounds, and nearly blinded herself cooking with Splenda. She used it in a dish she cooked on the stovetop and leaned over the pot at just the wrong moment. Splenda, it seems, contains chlorine, and apparently some of that chlorine is released during cooking. P. got a faceful of it and went temporarily blind. Luckily she got her vision back.

I thought about the long-running debate over whether aspartame (the artificial sweetener in Equal and NutraSweet) causes cancer. Well, actually, it does cause cancer in lab rats; the question is whether its carcinogenic properties extend to humans, and at what levels/doses. When I was growing up, my mother and grandmother and pretty much every grown-up woman I knew kept a little enameled or cloisonne pill holder in their purses. I used to beg my grandmother to let me use the tiny tongs that came with hers to drop sacccharine pills into her after-dinner coffee. My grandmother died of lymphoma, probably more closely related to her years of smoking than to her saccharine intake. Or was it?

I think Governor Paterson's tax has more to do with New York State's budget deficit than anything else, but I still have to wonder whether he thinks it's better to risk blindness or cancer than fatness. Remember that study where nearly 90 percent of people surveyed said they'd rather be blind than fat? I guess Governor Paterson has his finger on the public pulse after all.

New stuff at MP.org

If you haven't visited the Maudsley Parents site in a while, take a look. We've posted lots of new content, including a wonderful video interview about anorexia with Dr. Daniel le Grange of the University of Chicago, done by our own Jane Cawley. There's also new information in Spanish, a new article on eating disorders in boys, an updated and downloadable recipe collection, a video interview with Dr. le Grange on bulimia, and more. Plus there's a new search feature on the site.

Stop by and let us know what you think! Kudos to Jane Cawley for the new content and organization, and to Ann Farine, our web designer.

What I said

Nearly a year ago I wrote a post about Oprah's public battle with weight. Back then I wondered whether anyone could "win" the "battle of the bulge," if Oprah with all her money and resources couldn't.

Now the comment is a bit different: If Oprah, with all her ups and downs, her struggles to accept herself as she is, her repudiation of her body and her appetite, can't learn to love herself, then who can?

The answer: You can. I can. Even Oprah can.

But to do that, you've got to let go of the fantasy image of yourself as you wish you were.

You've got to grieve for the vision of yourself you've held dear for so long. You've got to grieve for that perfect you, the one who floats effortlessly through the world, svelte, unsinkable, emotionally airbrushed. You've got to learn to love instead what you've got: your thighs and your big heart, your dreams and your pores, all of them part of the same imperfect and vastly more interesting package than any airbrushed toothpick-thin fantasy could ever be.

Oprah, if you're reading this, I'm rooting for you--not to lose that weight again, but to gain something infinitely more precious: yourself.

Round-up time!

I've been a Very Bad Blogger recently, for which I am deeply sorry. :-) Here are a few tidbits to tide you over until I can come up with a brilliant new post.

First, 3 new studies looking for participants:

The Mount Sinai Eating and Weight Disorders Program is offering study treatment as part of a federally funded study (Principal Investigator: Katharine Loeb, PhD) for children and adolescents with symptoms of anorexia nervosa. If your child is 10-17 years old, is medically stable, and is developing signs and symptoms of an eating disorder, s/he may be eligible to participate. The study is approved by the Mount Sinai School of Medicine Institutional Board (Protocol 04-0978, approved through 8/31/09). For more information, call Lauren Alfano, 212-659-8724.

The University of Chicago is looking for adolescents with bulimia nervosa and their families for participation in a 6-month outpatient treatment research study. (Principal Investigator: Daniel le Grange, PhD) The purpose of this research study is to identify effective outpatient psychological treatments for adolescents with bulimia nervosa.
To be eligible the child must be between 12 and 18, be living with at least one parent, and have a diagnosis of bulimia nervosa or partial bulimia nervosa. Participating families will engage in 6 months of outpatient therapy for bulimia nervosa at The University of Chicago Hospitals. These treatments have the potential to bring about improvement in eating disorder symptoms. For more information, please call the bulimia nervosa treatment study at (773) 834-5677, email bulimia@yoda.bsd.uchicago.edu, or visit the Treatment of Bulimic Adolescents Study webpage.

The Johns Hopkins Eating Disorders Program is looking for women 18-40 years old with bulimia nervosa interested in a research study funded by the Klarman Family Foundation. (Principal Investigator: Angela Guarda, MD.) The study includes a health assessment, blood testing, and pictures of the brain taken using a medical scanner. Eligible women will be paid up to $400 for their participation and will be offered 6 weeks of outpatient treatment. Please call (410) 955-3863 for more information.


Next, mark another milestone in the Fight Against Good Foods/Bad Foods: Researchers in Spain have found that a handful of nuts added to your diet each day lower cholesterol and other cardiovascular risk factors. Whether this will actually decrease heart attacks and strokes is anybody's guess. The good part from my POV is that it moves nuts back out of the "bad food" category. Someday, somehow, we will abolish those categories . . . and this is a step in the right direction.

And finally, a shameless plug for my upcoming anthology, Feed Me!: The first review is in, and it's a good one, from Booklist. To see it, join the Feed Me! Facebook group--I've posted it there.

Send me your food/eating/body image news to get me through the grading of final projects. Thanks!

This is the way we legitimize fat prejudice

My local paper, the Syracuse Post-Standard, is really pretty good, especially for a small city paper. Like many small papers these days, it picks up a lot of stories from wire services. Today's post concerns one of those wire stories,which ran in the feature section as "10 simple things you can do today to improve your life."

Number 3 on the list is "Put one foot in front of the other." It's a plug for exercise, specifically for walking, which I am in favor of, and advocates getting a pedometer to measure your steps. We're all supposed to walk 10,000 steps a day. I'm good with that. But halfway through the item I came to this sentence:

Those in the obese range usually take between 4,600 and 6,000 steps a day, overweight people walk 6,000 to 7,000 steps a day, and those of normal weight tally 8,000 to 10,000 steps a day.

Where to begin: With the idea that anyone who's not overweight is "of normal weight"? (Since when is being underweight normal?) Or with the random declaration that obese people walk no more than 6,000 steps a day?

I've worn a pedometer, and I've typically taken between 7500 and 9,000 steps a day. I have to make a conscious effort to reach 10,000 steps a day, it's true, but according to this article, since my BMI is in the obese category, I should be more of a couch potato.

It's just another example of how silly these kinds of "health" stories can be. And as a member of the media myself, I really shouldn't get exercised (pun intended) about ridiculous things like this. But I do. Because every one of these stories underlines, subtly or overtly, our cultural attitudes and assumptions about fat people, and so leads to more fat prejudice and stereotyping.

And there's already plenty of that to go around.

Wanted: Snappy comebacks

It's inevitable: Whenever I see people I haven't seen for a while, one or two of them are sure to say something like "You've lost weight! You look so good!" Not because I've lost tons of weight. Maybe I've lost 5 pounds, but I really don't know (and don't care) and haven't weighed myself in months. I think it's because I'm happy. Oh, and my hair is longer.

The point is, I wish I had something to say in this situation. Yesterday an acquaintance gushed on and on about my putative weight loss, and I said, "No, I really don't think I've lost a lot of weight." Her response: "I beg to differ!"

Excuse me? You're telling me about my body? I know she meant well, but it was tres frustrating. I wish I had some snappy (but not snarky) comeback to offer in this situation.

Any suggestions?

Good Book, Bad Book

I can't wait till the latest round of kids'-books-to-combat-childhood-obesity passes. Each one seems more offensive than the last.

Today's review looks at I Get So Hungry, by adult fiction writer Bebe Moore Campbell, who died not long ago. I love Campbell's fiction--usually. But this book, like so many of its ilk, is nothing short of craptacular.

Its main character is a young girl named Nikky who is teased at school for being fat. Nikky is fat because she's a compulsive eater. She eats when she's sad, upset, angry, bored, and hungry. She eats junk food, and lots of it. When her adored and also fat teacher goes on a diet, Nikky wants to also, but her mother won't buy fruits and vegetables--not until she goes to a parent teacher conference and sees how skinny the teacher has become.

This book doesn't even pay lip service to the notion that people come in all shapes and sizes. It equates being fat with being emotionally dysfunctional and/or gluttonous. And it out and out lies: if you eat fruits and vegetables and walk every day, you'll lose lots of weight, according to the book. Oh, and come up with snappy putdowns for your tormentors.

By contrast, a wonderful book called Fat, Fat Rose Marie, by Lisa Passen, takes on the same subject matter--a little girl is teased for being fat--and handles it so much better. Rose Marie is befriended by another child who's the butt of teasing, because she has red hair and freckles, and together they empower each other and teach the other children to look beyond the surface to the person within. Rose Marie is never shown shoveling in food, as Nikky is; nor is she emotionally dysfunctional. She's just fat.

Lisa Passen's book was published nearly 18 years ago, proving once more that we're in a kind of Dark Ages when it comes to body image and weight. I can only hope we'll emerge sooner rather than later into our Renaissance.

What exactly is "moderate" exercise?

That's the question posed by a study in progress being done at the State University of New York and Syracuse University.

The Surgeon General recommends that everyone get 30 minutes a day of moderate exercise--but what, exactly, does that mean? Language is powerful but not always specific; what feels moderate to you might feel excessive to me, or maybe underwhelming.

Researcher Cameron Hall set out to explore people's perceptions of moderate exercise. I was lucky enough to be able to volunteer for the study, and it's been fun. On the first visit, I came into the lab, where they hooked me up to all kinds of monitors and meters and put me on a treadmill to measure my maximum exercise tolerance. They measured my oxygen consumption, heart rate, and perceived levels of exertion with one of those little charts where they ask you to point to how hard you think you're working. Pretty damn hard, by the end.

On the next visit, I was asked to walk around a track at what I thought was a moderate level of exercise. I booked it, let me tell you, wanting to surpass the researchers' expectations of me. I walked much faster than usual, averaging around 4 miles per hour instead of my usual 3.7. On the third visit, we were back in the lab, only now the researchers were telling me how fast and hard I had to work to hit the middle part of my range by the numbers.

It turned out that what I think of as moderate is nowhere near what the numbers say. Visit 3 was excruciating because we had to keep the treadmill flat for comparison purposes to the track we used on visit #2. I had to walk 4.2 miles an hour and even then could barely get into my moderate heart and oxygen consumption ranges. This might not have been a problem if I were, say, six feet tall. But I'm just about five one, and my legs just aren't that long.

So I learned what I personally have to do to get in the recommended half hour of "moderate exercise": Set that treadmill at 3.8 and crank up the incline to between 3 and 5 percent. I did it yesterday, and let me tell you, I was working hard. And that's what the researchers think will be the upshot of the study: You probably can't protect your cardiovascular health by strolling around the block with the dog or taking a leisurely stroll. You've gotta book it, baby.

What I love about this study is that it acknowledges both the power and pitfalls of language. Words are imperfect vehicles for expressing what we feel and what we know. But they're all we've got. Sometimes our task is to learn to use them more expressively. Sometimes, as in this case, our task is to connect them to cold hard facts.

The study results should be published within the next few months. I'll keep you posted.

Feed Your Head

It's official: You can pre-order my new anthology, FEED ME: WRITERS DISH ABOUT FOOD, EATING, WEIGHT, AND BODY IMAGE at Amazon. Yay!

I'm excited about this collection, if I do say so myself. There are some tremendous essays in here, from writers like Amity Gaige, the ever-hilarious Laurie Notaro, Caroline Leavitt, Ann Hood, Joyce Maynard . . . and, yes, yours truly. And they cover just about every aspect of our relationship with food. Plus the collection got awesome advance praise from Mary Pipher (one of my favorite writers), Betsy Lerner, Ellyn Satter (another one of my faves), and Nancy Redd.

Random House is producing a digital excerpt, with the introduction plus three essays. I'll load it onto the blog when it arrives.

Stay tuned. . . .

Support group meeting in Madison, Wisconsin

The Madison parents' support group is meeting tomorrow, November 11th. This group is for any parents interested in using family-based treatment (the Maudsley approach) for their child with anorexia or bulimia. Parents who aren't currently using it but who would like to know more are welcome to attend. This is a great and inspiring group of parents.

Where: Starbucks on University Avenue, Madison
When: 7 p.m.

No need to RSVP. If you want more information, please contact Denise Reimer at remier1@charter.net.

One result of the hype around "the obesity epidemic"

Thanks to fellow blogger Carrie Arnold over at Ed-Bites for picking up on this study out of Australia, which points out an alarming rise in both obesity and disordered eating--together, in the same people.

As Carrie and some of the commenters on her blog point out, many doctors would applaud weight loss in someone considered obese, no matter how s/he achieves it. As the study's authors write:

In recent years, the obesity ‘‘epidemic’’ has received much attention in the media and from politicians, public health promotion, clinical health professionals, and others treating obesity. Perhaps these confronting, and at times alarmist, messages, have been conducive to increased levels of body dissatisfaction among obese individuals, and to a perception that weight loss at any cost is the best outcome. This might also account for the observed increase in the prevalence of binge eating and extreme weight control behaviors, as body image dissatisfaction is a risk factor for disordered eating.

Weight loss at any price—that sums it up nicely. And when diets fail (as they nearly always do), some people turn, out of desperation, to restricting, purging, and other unhealthy behaviors. Teenagers are especially vulnerable, I think, because they get a heavy dose of judgment from both peers and doctors.

So if you're a pediatrician, I hope you'll take a closer look at this study and think about its implications. If you know a pediatrician, I hope you'll forward the study on. I think our best hope for change around this issue is not creating these attitudes in the first place.

Eat well. Exercise because it feels good. And love your body for its power, its strength, its beauty, and its sturdiness.

Blame it on the sertraline?

This story from the U.K. links sertraline--the generic name for the antidepressant Zoloft--to a young woman's death from anorexia.

"One of the side effects is the reduction of appetite," said the psychologist who treated the young woman.

What will it take to make people understand that anorexia is not the result of reduced appetite? That it's a brain disorder with genetic and biological underpinnings?

Many people (including myself) take sertraline without becoming anorexic.

Just once, I'd like to see a news story that showed a true understanding of anorexia. Just once.

Need a laugh?

Things have been a bit slow on the blog lately. Sorry about that--being a first-time professor takes up a lot of time, as it turns out! This post, The OCD Diet, should make up for that. Don't read this at work, unless you don't mind falling on the floor laughing hysterically in front of your colleagues.

We STILL don't get it

I was saddened to read today of a woman in York, England, who died of complications from anorexia. Carole Patrick had struggled with anorexia for 30 years, according to this article. Chronic malnutrition led to osteoporosis, which led to a fall that broke her hip and made it impossible for her to recover when complications developed.

But I was shocked to read this line, buried in the article:

York Coroner Donald Coverdale, recording a verdict of death by misadventure, said her death was the “unfortunate and unintended consequence of a medical condition arguably under her control."

You would think medical people, at least, would understand that anorexia is not a choice. Anyone who's ever watched someone they love suffer with an eating disorder understands this basic fact; why can't the medical profession get it?

A few paragraphs down, a spokeswoman for BEAT, a UK-based organization supporting people with eating disorders, had this to say about anorexia:

. . . disorders such as anorexia were not a “diet gone wrong” or a fad or a fashion. “They are a way of coping with difficult thoughts, emotions or experiences,” she said.

In some ways, this shocked me even more. This is the old psychodynamic perspective on eating disorders, one that has been in vogue for 50+ years. Only thing is, there's absolutely no evidence that it's true.

The latest research points to genetics and heritability as primary factors in eating disorders. EDs run in families. They're associated with clinical levels of anxiety. Many people have difficult thoughts, emotions, and experiences; very few of them develop eating disorders.

I don't expect most people to understand anorexia; we have a lot of educating to do. But I do expect medical people and organizations like BEAT to know better--or to stop speaking for all those with eating disorders.

Of parents, health, and eating

This semester I teach mainly seniors, and today I was asked by some folks in another part of the university to administer a health survey to my classes, to gauge the effectiveness of some "healthy living" efforts they've been working on for the last few years. I couldn't help noticing, as I collected the surveys, one line in particular. It was one of a series of questions about where these 22-year-olds get their health information. There were many choices (the internet, magazines, newspapers, classes, health initiatives on campus, etc.), and many of the students indicated that they didn't get health info from very many sources. The one source that almost unfailingly scored high: their parents.

That's right. Their parents. These young women (and a few men) have been living away from home for the last four years. They've been independent. They've traveled to Europe, many of them; they're close to starting their own adult lives. And yet they trust their parents more than almost any other source of health information.

I must admit that tears came to my eyes as I looked at survey after survey (just that one line, honest!).

This was especially moving and poignant given what I'd been reading earlier in the day: A book called Psychosomatic Families by Salvatore Minuchin, one of the founders of family systems therapy. Minuchin's work with families is often cited as one of the inspirations for family-based treatment of anorexia and bulimia. Until Minuchin's work, patients were routinely separated from their parents and treated (usually ineffectively) individually. Minuchin was one of the first to see patients as part of a bigger family system.

Unfortunately, his view of families was anything but positive. The title says it all: Instead of psychosomatic patients, he believed in psychosomatic families--families that through enmeshment, conflict avoidance, triangulation, and other unlovely psychodynamics created children who expressed their emotions through illness. Interestingly, Minuchin writes that he developed the idea of psychosomatic families after treating diabetic children who managed their blood sugar fine in the hospital but who had crisis after crisis when they were at home. His theory was that emotional stress at home was affecting the kids' blood sugar levels.

It's an interesting theory, and I think there's some merit in it, but not for the reasons Minuchin believed. As this rather technical article discusses, stress early in life can lead to permanent changes in physiology--in this case, rats' guts became more permeable, leading to more gastrointestinal symptoms. The idea is that some of us (rats or humans) may be more genetically predisposed to such stress mediation than others. Genes load the gun, environment pull the trigger.

For Minuchin, though, it was all environment. He blames parents for pretty much everything. For those of us who have parented children with eating disorders, his book is painful reading. For instance, Minuchin describes a family at the table with their anorexic daughter. Each parent tries to cajole, threaten, and inspire the child to eat. The child does not eat. Minuchin deconstructs the parents' behaviors as "enmeshment."

He was way off base on that one. By the time a child is in that kind of trouble with anorexia, of course parents are going to be trying to get her to eat. And of course they're going to be unsuccessful, unless they're empowered or supported by the treatment and/or professionals. Sitting in a room with a one-way mirror, pleading with their child to eat, most parents will look enmeshed and ineffectual.

Which is why I was so moved to see those answers on the surveys today. One of the fundamental principles of the Maudsley approach is that families love their children and are best positioned to support and help them through one of the most devastating experiences of their lives. Critics of Maudsley say the treatment fosters an inappropriate "enmeshment" (that word again) between parents and children. Proponents say Maudsley leverages the asset that already exists: the strong and loving relationship between parent and child.

Not all families are healthy. Not all families are functional. Not all parents love their children. But most do. And if those surveys are correct, for many adolescents and young people, parents are still an important part of the picture. And not in the way Minuchin imagined.

Update: Rogers Hospital

I got an email from the family whose daughter was being held hostage at Rogers: Their daughter came home last night. Against medical advice, but she's home.

Sounds like Rogers was still trying to bring the county in, right up to the last minute, but the family had done their homework and was able to challenge Rogers' assertions.

Now, of course, comes the truly hard part: re-feeding a 13-year-old with anorexia. But this is a wonderful example of how families that are empowered can accomplish near miracles--especially when they're motivated by love of their children.

To the family: You are awesome. As hard as re-feeding is, I found it infinitely preferable to be doing it myself, at home, rather than be far away, feeling helpless about whether my daughter lived or died. We're all rooting for you.

America the Beautiful

Anyone out there see this movie yet? I'd love to hear a report from someone who's actually had a chance to watch it. It hasn't come to Syracuse yet as far as I know. The trailer, which you can watch online, looks great.

Beacon Street Girls: books to help teens lose weight

I'd love to see readers of this blog weigh in on this post by the usually savvy Tara Parker Pope in her Well blog at the New York Times. From the comments on the blog so far, most readers just ain't getting it. You can help. :-)

Why I don't recommend Rogers Memorial Hospital: Part II

Last year I wrote about the cognitive dissonance between the marketing materials produced by Rogers Memorial Hospital, in Oconomowoc, Wisconsin, and its actual therapeutic programs and practices.

That post produced a letter from Rogers' CEO himself, complaining about my "airing my grievances in a public forum" rather than talking directly to him about them.

Dude, that's what blogging's all about. Besides, I can imagine how open he would have been to my criticisms. Yeah, right.

This time around, I'm not just writing about presentation. I'm writing about practice, therapeutic practice as it's being executed at Rogers. And it stinks.

It seems that Rogers has changed its practices around the use of feeding tubes for anorexic patients. In the past, feeding tubes were considered something of a measure of last resort, sometimes necessary to save a life but something to be avoided when possible.

Not anymore. And not only that: feeding tubes are being used to keep patients at Rogers when parents want to bring them home.

Case in point: A family whom I'll call the Smiths, whose young adolescent daughter was admitted to Rogers a few weeks ago. The family was told the girl must have a tube, and although they weren't in favor, the tube was administered. Fast forward 10 days or so. Rogers is telling the family the girl has made "little progress" and urgently needs admitting to its 30-day residential program. Family can get no information on why so little progress has been made, even with the tube. Family has been researching, and has decided they want to use family-based treatment, the Maudsley approach, to help their daughter. Family tells Rogers of their intentions and asks when daughter may be safely transported home.

Next thing family knows, their local county department of child protection services is threatening to remove their daughter from their custody if they take her home. Rogers continues to insist that daughter cannot be moved so long as she's on the tube. Family says most girls with their daughter are also on feeding tubes, which constitutes a large shift in treatment protocols at Rogers.

The girl is eating. She's terrified. She wants to go home. Her family wants to bring her home for FBT. Rogers, which claims that it incorporates some FBT in its therapeutic protocols, is playing dumb and insisting that FBT would constitute child abuse and that the girl cannot safely be sent home.

The therapists at Rogers are (or should be) familiar with the studies on FBT, which show that it is very successful for adolescents under 18 who have been sick for less than three years. (It's been successful for others, too, but there are no studies yet on those populations.)

Their actions in this case and others are deeply disingenuous. Feeding tubes are a necessary evil at times. But families should be the first line of treatment and support for adolescents--especially when the family is committed to the task of helping their child recover.

Shame on Rogers.