"You've lost weight!"

That's what a colleague said to me yesterday, a woman I haven't seen for six months. A woman who is tall and broad and neither thin nor fat.

I haven't lost weight; if anything, I've probably gained a pound or two. Which is irrelevant, really, because I've had people say this to me whether I've lost or gained or stayed exactly the same.

And it's a comment I never know how to respond to, because there are so many assumptions wrapped up with those three little words: The assumption that I'm trying to lose weight, or at least wishing to. The assumption that losing weight will make me look better. That assumption that losing weight, or trying to, is a positive thing. The assumption that it's OK for someone I don't know well to comment on my appearance.

I've considered a variety of responses to this comment, everything from "Please don't comment on my appearance" to "Thanks." What I said yesterday was a simple, "Actually, I haven't."

My colleague persisted. "No, you really have," she said. "You look--" She gestured toward my body. "Maybe it's the shirt," she said.

"Maybe," I said. I walked away feeling ungracious. Should I have said thank you? In our culture, telling a woman she's lost weight--especially a woman who is not thin--is a compliment and a social offering. I like this colleague a lot; I know she meant well. Yet I'm very uncomfortable at this point with comments like this. They are also teachable moments. But, you know, sometimes I get really tired of teaching.

I'm not sure I said the right thing. I'm not sure what the right thing is. Any thoughts?

Have you ever been on the receiving end of weight-based discrimination?

If so, I'd like to hear from you. I'm doing a story for the NY Times science section on this and would like an anecdote or two, especially having to do with work, jobs, etc.

Email me at harriet at harrietbrown dot com.

What the World Eats

Today I stumbled onto this fascinating excerpt from a book called Hungry Planet, which was serialized on the Time magazine website when it came out a few years ago. Photographer Peter Menzel and writer Faith D'Alusio visited 30 families in 24 countries to research this collection of portraits. Each family is shown with a week's worth of food, along with the cost of that food (in local money and in U.S. dollars), plus a list of the family's favorite foods and/or recipes.

The photos are eye-opening, literally, especially when you compare, say, the abundance and variety of foods eaten by a family of four in Germany (cost: about $500 a week) with the much more meager and monotonous foods eaten by a family of five in Chad (cost: $1.23). The lists of favorite foods include everything from rice to polar bear to pastries.

There's something quite wonderful about the way these photos show us, without posturing or judgment or politics, each family's relationship with food. I was especially captivated by this as I've been contemplating a similar personal photo project. But this is so much better.

Is Your Child One of the 12 Percent?

One of the things you hear a lot these days--at least if you spend any time talking to doctors about eating disorders--is that they affect a relatively small number of kids. Prevalence rates for anorexia are usually quoted as .5 to 1 percent, and 3 to 6 percent for bulimia. (Binge eating disorder is a newer diagnosis; I've heard 3 percent for BED but don't know if it's accurate.) Which somehow makes them less worthy of attention, concern, and research money than, say, childhood obesity, which as we all know is public healthy enemy #1. (That's sarcasm, y'all.)

But a new study out of University of Texas at Austin shows that fully 12 percent of all adolescents experience some form of eating disorder. That's 12 out of 100. Which may not sound like much.

But consider that 1 out of 15,000 kids gets cancer of some kind, and think about the attention and research and money devoted to understanding and treating childhood cancers. Then think again about the number: 12 percent.

It sounds a lot bigger now.

One of the pervasive problems in treating eating disorders is a lack of effective treatments. We need more research, which needs we need more research dollars. One reason we don't get those dollars is that families are often reluctant to acknowledge that their child has an eating disorder because of the stigma associated with these illnesses.

Cancer used to carry a lot of stigma, too. As a culture we've mostly gotten over that. How about we start challenging the stereotypes around eating disorders? Parents could be amazing advocates, if only we were willing to stand up and say, "Yes, my child is one of the 12 percent--now what are we going to do about it?"

How about it?

See you in . . . October?

For those of you in the D.C. area, I hope you'll join me and some very special guests at a conference on eating disorders, hosted by Maudsley Parents. This half-day get-together features two of the leading researchers in the field of eating disorders, both of whom are accessible, compelling speakers. Daniel le Grange heads up the University of Chicago's Eating Disorders Program; Walter Kaye directs the University of CalIfornia-San Diego's program.

Dr. le Grange will discuss family-based treatment (the Maudsley approach) for both anorexia and bulimia. Dr. Kaye will give us insights into the neurobiology of eating disorders. And I'll share my family's story and offer parents specific strategies and tips for helping a child through an eating disorder.

You can find more information and sign up for the conference here. (If you sign up before September 14, the cost is only $25 per person.) I hope to see you there!

Et tu, New York Times?

Funny--I just spent an hour on the radio talking about the stigma of being fat, and lo and behold, this incredibly mean-spirited snarky piece appears in the New York Times.

I'm happy to see that Jezebel called the Times out for this offensive story, which includes paragraphs like this one:

The petites section features a bounty of items for women nearly as wide as they are tall; the men’s Big & Tall section has shirts that could house two or three Shaquilles. And this is really, remarkably smart.

The writer, Cintra Wilson, seems unfamiliar with the concept that fat people wear clothes and spend money too.

I think this is a job for the Times' public editor, don't you? You can email Clark Hoyt at public@nytimes.com.

Fat acceptance on Radio Times

I just finished doing a call-in show on Radio Times, a public radio show on WHYY, on fat acceptance and on our relationship to food and eating and weight. It was a good show, and included some excellent comments from Rebecca Puhl of the Rudd Center for Food Policy and Obesity at Yale.

You should be able to listen to an archived version of the show here eventually.

I thought it was interesting, and somewhat sad, that pretty much all the callers espoused the "thin-is-healthy" and "thin-at-any-cost" idea. For those of you who may be finding this blog after hearing the show, I'd love to direct you to a couple of good resources.

I hope you'll check out Ellyn Satter's wonderful website and books. Satter, a nutritionist, therapist, and researcher, advocates for what she calls competent eating--meaning, eating in a way that satisfies your hunger and your appetite. She writes about the need to develop a joyful relationship with food and eating--a radical concept in our current culture, and one worth considering.

One of the callers mentioned anger and snarkiness among the Fat Acceptance blogs. I don't know how you define snarkiness, exactly, but I quite like some of the FA blogs, including Shapely Prose, The F-Word, and The Fat Nutritionist.

Finally, in my recent book, Feed Me: Writers Dish About Food, Eating, Weight, and Body Image, I published a Love-Your-Body pledge, which is also available here. I hope you'll consider signing it. Paste it up where you'll see it everyday, and remind yourself about what you love and appreciate about your body.

Bob Herbert: What he said

Read it here.

Thanks, Bob.

Obesity & eating disorders: the link

Researchers at the University of Minnesota (where, 60 years ago, Ancel Keys did his pioneering work on starvation) are beginning to quantify the links between overweight and eating disorders in kids. Their newest study looks at the risk factors that make overweight teens vulnerable to behaviors that are part of eating disorders: self-induced vomiting, using diet pills and laxatives, and binge eating. They also look at socio-cultural factors that contribute--reading a lot of magazines articles about dieting, for instance.

The research is led by Dianne Neumark-Sztainer, who's done some excellent work on weight over the years. It's worth checking out, especially in light of our current hysteria around obesity and the plethora of intervention efforts aimed at kids, which I fear are creating a tidal wave of eating disorders. (They certainly don't make kids thinner.)




Thanks to Jane for pointing out this research!

Save the date: October 5

Please join Maudsley Parents for a half-day afternoon conference on family-based eating disorders featuring two of the research world's heaviest hitters (and best speakers): Dr. Walter Kaye, of UC-San Diego, and Dr. Daniel LeGrange of University of Chicago, co-author of Help Your Teenager Beat an Eating Disorder. Yours truly will also speak.

The conference will be held at the Bethesda Marriott in Bethesda, Maryland. More details to come--stay tuned!

Sneak peek: Prologue

Hello all,

I appreciate very much the community that has developed around this blog (and others) over the last few years. Which is why I'm asking if you will do me a favor and read the prologue of the book I'm working on, tentatively called THE DEMON IN THE BAKERY. It's a family memoir about my daughter Kitty's anorexia and recovery.

Warning: This prologue may be triggering for those who are actively eating-disordered or in recovery, so please, skip it.

The rest of you--I'd value your honest reactions and feedback.

Thanks.



PROLOGUE: THE DEMON IN THE BAKERY

Close your eyes. Imagine that you’re standing in a bakery. Not just any bakery—the best bakery in Paris, its windows fogged, crowded with people who jostle for space in front of its long glass cases. The room is fragrant and you can’t take your eyes off the rows of cinnamon rolls and croissants, iced petits fours, flaky napoleons and elephant ears. Every counter holds at least one basket of crusty baguettes, still warm from the oven.
And you’re hungry. In fact, you’re starving. Hunger is a tornado whirling in your chest, a bottomless vortex at your core. Hunger is a tiger sharpening its claws on your tender insides. You stand in front of the glass cases, trying to swallow, but your throat is dry and your stomach clenches and contracts.
You want more than anything to lick the side of an éclair, swirl the custard and chocolate against your tongue. You dream about biting off the end of a cruller, feeling the give of the spongy dough, the brief molecular friction of the glaze against your teeth, flooding your mouth with sweetness. The woman beside you reaches into a white paper bag, pulls out a hunk of sourdough roll. You see the little puff of steam that flares from its soft center. She pops it into her mouth and chews and you chew along with her. You can almost taste the bread she’s eating. Almost.
But you can’t, not really, because how long has it been since you’ve tasted bread? A month? A year? An eternity. And though your stomach grinds against your backbone and your cheeks are hollow, though the tiger flays your belly, you can’t eat. You want to, you have to, but your fear is greater than your hunger. Because when you do—when you choke down a spoonful of plain yogurt, five pretzel sticks, a grape—that’s when the voice in your head starts up, a whisper, a cajoling sigh: You don’t need to eat, you’re strong, so strong. That’s right. Good girl.
Soon the whisper is a hiss filling the center of your head: You don’t deserve to eat. You’re weak, unworthy. You are disgusting. You don’t deserve to live. You, you, you. The voice is a drumbeat, a howl, a knife sunk in your gut, twisting. It knows what you’re thinking. It knows everything you do. It has always been inside you and it always will be. The more you try to block it out, the louder it becomes, until it’s screaming in your ear: You’re fat. You’re a fat pig. You make everyone sick. No one loves you and no one ever will. You don’t deserve to be loved. You’ve sinned and now you must be punished.
So you don’t eat, though food is all you think about. Though all day long, wherever you are—doing homework, sitting with friends, trying to sleep—part of you is standing in the bakery, mesmerized with hunger and with fear, the voice growling and rumbling. You have to stand there, your insides in shreds, empty of everything but your own longing. There will be no bread for you, no warm, buttery pastries. There’s only the pitiless voice inside your head, high-pitched, insistent, insidious. There’s only you, more alone than you’ve ever been. You, growing smaller and frailer. You, with nowhere else to go.
The voice is part of you now, your friend and your tormentor. You can’t fight it and you don’t want to. You’re not so strong, after all. You can’t take it and you can’t get away. You don’t deserve to live. You want to die.
This is what it feels like to have anorexia.

* * *

I’ve never had anorexia, but I’ve lived with it. I’ve observed it closely in someone I love: my oldest daughter, Kitty, who was 14 when she got sick. I watched as the happy, affectionate girl I knew became furious and irrational, obsessed with food but unable to eat. I saw her writhe in terror, heard her beg my husband and me for help and then, in the same breath, shriek that we were trying to poison her, to make her fat, to kill her. I heard a voice I did not recognize come out of her mouth, saw her gaunt face changed beyond knowing. I held her in my arms and felt the arc of every rib, counted the bones in her elbows, saw her breastbone press out through the paper-thin skin of her chest. I felt her body shake and knew that whatever comfort I offered it wasn’t enough, it was nothing in the face of the thing that was stripping the flesh from her bones and the light from her eyes.
I had no idea anorexia was like that.
Before Kitty got sick, I thought eating disorders happened to other people’s children. Not to my daughter, who was savvy and wise, strong and funny, the kind of kid who picked her way through the pitfalls of toxic middle-school friendships. She did fit the profile: she was a perfectionist, fastidious about how she looked and dressed. She was hard on people sometimes, especially herself. She was athletic, a gymnast, traveling around the Midwest for meets; her favorite event was the balance beam—fitting, I thought, for a child who so gracefully walked the line between childhood and adolescence.
But she would never have an eating disorder. She was way too smart for that.
Before my daughter got sick, I thought kids with anorexia or bulimia wanted attention, that they were screwed up and tuned out, bored or acting up or self-destructive. But my daughter was none of those things. She seemed cheerful and well adjusted; she had friends, interests, a passion for new experiences. She wrote her sixth-grade research paper on eating disorders. She knew the dangers. She would never choose to have anorexia. She was safe.
I was wrong about many things, but I was right about that one thing: Kitty didn’t choose anorexia. Anorexia chose her. And it nearly killed her.
At Kitty’s lowest weight, her heart beat dangerously slowly; it could have stopped at any time. Between 10 and 20 percent of people with anorexia die from heart attacks, other complications, and suicide; the disease has the highest mortality rate of any mental illness. Or Kitty could have lost her life in a different way, lost it to the rollercoaster of relapse and recovery, inpatient and outpatient that eats up, on average, five to seven years. Or a lifetime: only half of all anorexics recover in the end. The other half endure lives of dysfunction and despair. Friends and families give up on them. Doctors dread treating them. They’re left to stand in the bakery with the voice ringing in their ears, alone in every way that matters.
Kitty didn’t choose anorexia because no one chooses anorexia, or bulimia, or any other eating disorder. Intelligence is no protection; many of the young women (and, increasingly, men) who develop anorexia are bright and curious and tuned in. Families are no protection, either, because anorexia strikes children from happy families and difficult ones, repressed families and families who talk ad nauseam about feelings. The families of anorexics do share certain traits, though: A history of eating disorders, or anxiety, or obsessive-compulsive disorder. Or all of the above.
I’ve never had anorexia, but I know it well. I see it on the street, in the gaunt and sunken face, the bony chest, the spindly upper arms of an emaciated woman. I’ve come to recognize the flat look of despair, the hopelessness that follows, inevitably, from years of starvation. I think: That could have been my daughter. It wasn’t. It’s not. If I have anything to say about it, it won’t be.
This is the story of our family’s struggle. Kitty was diagnosed with anorexia in June 2005. In August of that year we began family-based treatment (FBT), also known as the Maudsley approach, to help her recover. That was the start of the hardest year of our lives and, especially, Kitty’s. That year, I learned just how brave my daughter is. Five or six times a day, she sat at the table and faced down panic and guilt, terror and delusions and physical pain, and kept going. And she emerged on the other side. After months of being lost, she came back to us and to herself, and the world took on color and sound and meaning once more.
So this book is for Kitty, and for all the children and teenagers and adults who have struggled or continue to struggle with an eating disorder: for your courage, your strength, your capacity to not just endure but overcome. I honor you with every word.

10 reasons why BMI is bogus

I love, love, love this piece from NPR on the top 10 (suggesting there are more than 10) reasons why BMI is a bogus measurement. My favorite:

The person who dreamed up the BMI said explicitly that it could not and should not be used to indicate the level of fatness in an individual.

Go read the rest for yourself.

Hey kids!

Want to develop a lifelong obsession with eating? How about an eating disorder? Or at the very least years of self-loathing toward your body? Have we got an idea for you! Start writing down everything you eat. That's right--every single bite you eat goes into this handy-dandy food journal that the folks at the Washington Post think you should keep.

Start now! Before you know it, you'll be on your way to a lifetime of unhappiness!

Grrrrr.

Listen in . . .

. . . to a fabulous radio show hosted by Susan Barnett of 51%, on body image, dieting, and anorexia. Barnett held a roundtable with four contributors from Feed Me, and then graciously gave me some airtime for a commentary as well. Good stuff.

Offline

I can't tell you how much I appreciate everyone who reads and comments on this blog. It means a lot to me to have the kind of thoughtful, intelligent discussions we do here with all of you.

For the next month or so, though, I'll be offline at a writing retreat. I hope to emerge refreshed and mostly through done writing my next book, BRAVE GIRL EATING.

Happy June!

Has your family been denied insurance coverage for an eating disorder?

I got a call this morning from a staffer at Good Morning America, looking for families to profile and potentially help with insurance coverage. If you're interested please get in touch ASAP.

Interview on True/Slant

Katie Drummond is an interesting young Canadian writer living in NYC and writing for a site called True/Slant. She interviewed me last week for the site, and here's a link to the results of that chat. It's always good to see eating disorders covered intelligently rather than in the Madonna/whore way of most media outlets, where people are either "accused" of having anorexia or ridiculed for being fat because they're wearing size 2 jeans.

Knitting and EDs

I have to admit my eyebrows went up when I first read about this study, which looked at whether the act of knitting could help people recovering from eating disorders. There are a lot of wacky, unproven, and frankly ridiculous "therapies" out there for eating disorders, many of which are rubbish.

But this one actually makes sense. Researchers from the University of British Columbia, Oxford University, and the Beau Cote Centre for Eating Disorders looked at whether the repetitive act of knitting could help with the inevitable anxiety and perseveration that comes along with the recovery process. While their study sample was small--38 women on an ED ward in a hospital--the results suggest that knitting did in fact have something of a calming and even therapeutic effect.

I can understand the principle: For me, washing dishes or weeding provides a similar effect. Human beings are hard-wired to work with our hands. And repetitive work like knitting can facilitate a zenlike meditation state that can be very soothing.

I like the fact that the researchers aren't claiming that knitting helps people recover from EDs. They point out instead the secondary but still important component of anxiety management. And I know not only from my own experience but also from Ancel Keys' Minnesota Starvation Study that anxiety is a major biological component of re-feeding and recovery.

And if knitting helps with anxiety, I'm sure there are other activities that do the same, that help break the cycle of obsessive thinking that comes along with EDs. Maybe crocheting? Quilting? Fiber arts as ED recovery corollaries? I love it.

Families and eating disorders

This story in the Gloucester Daily Times makes me see red. Literally. For its seemingly complete ignorance of the genetics of not just eating disorders but also personality traits like perfectionism, ambition, etc. The story reads as if whenever something goes wrong it's got to be the family's fault.

We know that it just isn't this simple. Fellow blogger Carrie Arnold summed it up wonderfully in this post. We also know that the blam-and-shame game undercuts families, who are often the best (or only real) resource for someone with an eating disorder.

So knock it off, will you? You're not helping. In fact, you're hurting families and sufferers alike. Do some reading. Do some thinking for a change. Then try your hand at some responsible journalism.

They don't even know they're doing it

Like most smallish local newspapers these days, the one in my town picks up a lot of copy from various sources. I'm not a fan of such content recycling, though I understand why it's done.

This item is the kind of thing I mean: a list that ran in a section called The Daily Dose, under a headline reading "Indulge, But Not Too Much." The intro copy reads "Almost everyone needs to indulge once in a while, so why not today, Memorial Day? Here are some ways to limit the damage, nutritionists say:"

Then follows a list of seven tips. Here's number 1 (the quotes are from the original):

Keep it occasional. There's nothing wrong with a little "cheating." Whether it's once a day or once a week depends on your weight, health, overall diet and activity level.

Can I tell you how many ways from here to next week this pisses me off? For starters, the assumption that everyone who reads this is on a diet. And not only are they on a diet, they're always on a diet. Hence the word cheating.

Wake up, people. Diets don't work. You know it, I know it, and researchers at UCLA said so several years ago, so it must be true. Yet this inane little piece assumes that everyone is continually on a diet. Or should be.

It's the assumption that gets me: the idea that any "indulgence" constitutes "cheating," that your entire life is supposed to be spent restricting what you eat, counting calories and fat grams. This assumption underlies 95 percent of the ongoing cultural conversation. It's so insidious we don't even name it, much less question it.

And check out the infantilizing language around this: We indulge like naughty children. We cheat like even naughtier children. When we're not being good, we're being bad. And like naughty children, we must be punished for our transgressions--in this case, by threats of the "damage" we're causing ourselves, and with warnings about how being fat will kill us.

I hated this kind of thing when I was 5. I damn well hate it now.

We don't hear much about findings like this one, which show that overweight heart attack survivors outlive thin ones, including those who follow the doctor's orders and lose weight after a heart attack.

My point is that by now, the bias against fat in every form is so widespread, so widely accepted, that to question it is the equivalent of throwing a rock through the neighbor's window: being a naughty child par excellence.

I wish the editors at my local paper had thought about this item before they plugged it into the hole on the features page*, but I really can't blame them. In 21st-century America, it's far worse to be fat than to be unfaithful to your spouse, to bilk your investors, to not give to charity. Several years ago, researcher Abigail Saguy coined the term moral panic to describe the way we talk and think about being fat in this society. I would add "unthinking, unquestioning moral panic." As items like this underscore all too well.


*In many ways, it doesn't even make sense. The list goes on to suggest that you "eat the real stuff" like ice cream (though only a half cup! Never more than that!) and "mix salt with fat" by adding peanut butter to your pretzels, but ends with the admonition, "Pretzels and baked potato chips are examples of tasty snacks without artery-clogging trans fats." Hello, how do you think we got to where we are now? It wasn't until the low-fat craze of the 1980s that Americans' weight began to rise.