Anorexia ≠ autism

Of late, several researchers have been exploring a possible link between anorexia nervosa and autism spectrum disorders. I've never understood why. It seems fairly clear to me that acute anorexia brings with it an altered state of consciousness that has little to do with a person's ordinary state of mind or ability to interact with people. In his seminal study on human starvation, researcher Ancel Keys noted that those in the throes of semi-starvation tend to lose both the interest in social interactions and the ability to pull them off. That certainly echoes my own observations.

Now, thankfully, researchers at King's College in London have come to the same conclusion. The study's authors write, "These findings indicate almost complete normalization of emotion recognition ability in recovered patients, despite the observation of difficulties in both domains in currently ill patients. Findings suggest that similarities between AN and ASD are restricted to the currently ill AN state and such difficulties in AN may be a factor of starvation."

Now, can we move on to more fruitful avenues of research, please? Like developing effective treatments?

"Plus-sized" models in a mag spread

While I question the plus-sized designation on some of these women (one is a size 10, which is plus-sized only in the insane world of fashion), I love these elegant spreads from an Australian magazine called Madison. A shout-out to Australian blogger Julie Parker for linking them on her blog, Beautiful You.

Follow-up: Lincoln University

According to the Associated Press, Lincoln University has dropped its requirement for fat students to take a special fitness class.

But, you know, they still don't get it. Because apparently, some freshmen will have the course "suggested" to them after they take a health class.

Dudes, when are you gonna cotton on? If the class is really all about health, and you think it's important, all students should take it.

And if it's all about weight loss? No students should take it.

A few thoughts on "refusal"

One of my gripes with the current thinking about eating disorders lies in the very definition of anorexia nervosa, as found in DSM-IV, the psychiatric bible:

Refusal to maintain body weight at or above a minimally normal weight for age and height.

It's the word refusal, frankly, that bugs the hell out of me, with its implication of volition. It suggests that people with anorexia nervosa could maintain their body weight, if they really really wanted to, which suggests, in turn, that AN is a disease of choice.

Nothing, in my experience, could be further from the truth.

So I was delighted to read, in the November issue of the International Journal of Eating Disorders, a literature review by Harvard Medical Schools' Dr. Anne Becker recommending that the word be changed in the next edition of the DSM. According to Becker, "The term 'refusal" in AN criterion A is potentially inaccurate, misleading, and pejorative." Woo-hoo! It doesn't get any more straightforward than that.

Becker, et. al., go on to write:

By implying agency and willfulness, the phrasing . . . may promote stigmatization of AN. In particular, the connotation of the word 'refusal' as behavior that is oppositional may perpetuate the notion that a patient is in control of her symptoms. Research has highlighted the stigmatization of AN both by the public, who appear likely to blame the patient for her illness and to believe she could "pull herself together" if she so desired, and by medical professionals.

Thank you, Dr. Becker, for setting the record straight. May the rest of the ED treatment community take your words to heart.

Lincoln University: Epic fail

Lincoln University, a historically black college in southern Pennsylvania, has made the news recently for jumping on the now-mandatory "wellness" bandwagon. As reported in the Chronicle of Higher Education, Lincoln's version is to institute a policy of weighing and measuring all freshmen; those with BMIs over 30 are required to take a one-credit course called "Fitness for Life" sometime before they graduate.

This policy exemplifies the worst of what's wrong with the way we as a culture approach fitness, health, and wellness. Like so many other institutions jumping on this bandwagon, Lincoln makes a fatal error in logic: It conflates weight with fitness.

So heavier freshmen at Lincoln are assumed to be "unfit" and "unhealthy." Just as bad, thinner freshmen are given a pass on the fitness course, the assumption being that they don't need it because they're not that fat.

If fitness and good health are the goals, shouldn't everyone have to take the course?

Some people object to the fitness course on libertarian grounds. Not me. I think good health and fitness is part of what we should be teaching children and practicing ourselves. But threatening or punishing larger people because of their size is not a useful strategy. As a researcher from the National Institutes of Health said recently, the number-one cause of obesity in this country is dieting. Programs like this buy in to the fat-is-unhealthy mindset. They also buy in to the thin-is-healthy mindset. By conflating weight with disease they do everyone a grave disservice.

My own school, Syracuse University, is looking at "wellness" programs right now. I hope I don't have to write a piece like this about SU someday.

PSA: Why you should always hire a trained journalist

Because if you don't, your newscasts will look like this.

BODYTALK: The video

Sara Sultanik, a talented grad student here at Newhouse, put together this cool video about the BODYTALK project. Thanks, Sara!

Everyone else--what are you waiting for? I'd love to get an MP3 from you for the BODYTALK project.

Newsflash: HAES Really Works!

At least, according to researchers at Laval University in Quebec, who have just published the results of a randomized trial comparing Health at Every Size with other food-related interventions.

The study involved premenopausal women considered overweight or obese, who spent time either in an HAES group, a support group, or a control group. A year after the trial had ended, the women in the HAES group had less "situational susceptibility to disinhibition," meaning they were less likely than women in the other two groups to overeat when triggered by stress, abundance, and other external situations. Women in both the HAES and support groups ate less in response to perceptions of hunger.

I'm a little irked that the ScienceDaily writeup of the study refers to HAES as a "new weight paradigm." But hey, it's still good news, and the beginning, I hope, of more studies looking at the benefits of HAES. Now, if only I could get these study results to the last group of doctors I spoke to . . .

Project BODYTALK: Anyone can record a commentary

I was interviewed this morning for the SU campus newspaper about Project BODYTALK. The reporter asked me an interesting question: Do I think that the act of telling your story around food and body image is healing? Is that what I hope to accomplish through this project--healing for the people who tell their stories?

My answer: Absolutely. But I also know that healing--in whatever form--will also happen through listening to these powerful stories.

To that end, I'd like to collect as many commentaries as possible. You don't have to have an eating disorder or serious body image issue to tell your story--in fact, I'd like to hear from people who feel good about their bodies, too!

Project BODYTALK starts today on the Syracuse University campus--but you don't have to come to campus to participate. Record your commentary in the privacy of your own living room and send it to me as an MP3 file. Please say your name and age at the start of the recording; if you want to remain anonymous, say that on the file too, and I'll edit it out.

If you want to submit a file, send it to hnbrown at syr dot edu.

If you're in or near Syracuse, come on down to the BODYTALK audiobooth any day this week or next between 3 and 8 p.m.: Newhouse 2, Room 472, studio P.

I hope to hear your story.

The BODYTALK project

If you live in central New York, please come participate in the BODYTALK project at Syracuse University. It's modeled after NPR's Storycorps booth, a traveling audio booth where people could record anonymous commentaries about things that mattered to them.

BODYTALK gives people a chance to record commentaries about their relationships with their bodies, appearances, food, eating, and weight. For the first two weeks of November, a recording studio at SU's Newhouse School of Public Communications (where I teach) will be set aside for anyone who wants to record a commentary. You can give your name or do it anonymously. Some commentaries will air on NPR's national show 51%; others will, I hope, be published eventually on a website.

If you can't get to Syracuse, you can record your own commentary and send me the mp3 file. I'd love to have as many people as possible take part in the project.

Who: Anyone!
What: Record a commentary (between 3 and 10 minutes long) in
Newhouse 2, Room 472, Suite P
When: Nov. 2-13; most days 3-8 p.m. (sign up at suite P, or walk
in at any time)

Because the more we talk about these feelings, the more shame and stigma will fall away.


*Photo originally published by Roosevelt University.

Help a grad student

Tina Indalecio, who's getting her PhD at Fielding Graduate University, is running a survey on how advertising media affects people with eating disorder or body image issues. I'm all for anything that helps with research around eating disorders, because God knows there's not very much of it.

So if you'd like to help Tina, you can read more about her research and/or take her survey here. The password you'll need is temp1212. The deadline for participating is Wednesday, October 28, by 11:45p.m.

You can also check out Tina's blog here, and her documentary project here.

Watch and learn

Even I'm surprised by some of what I saw in another of the Dove Campaign for Real Beauty videos. . . .




**Thanks, Erik, for sending it my way.

Interview with Dr. Katharine Loeb

Here's the latest in a series of video interviews with some of the top researchers in the field of eating disorders, done by Jane Cawley, co-chair of Maudsley Parents. This interview with Dr. Katharine Loeb of the Mt. Sinai School of Medicine offers sound, practical advice for parents of teens with anorexia.

Anorexia Nervosa in Teens: What Parents Should Know from Jane Cawley on Vimeo.

Take a look. Let me know what you think.

In honor of the High Holidays. . . .

Long before anorexia came to our house, I refused to fast on Yom Kippur. I understand the idea behind a 24-hour fast: to "cleanse" the mind of its emphasis on the corporeal, and to refocus it for a time on the spiritual.

For me, though, a fast made me think more about my body and its needs, not less. Standing in synagogue, beating my breast, all I could think about was food and hunger.

At 13, the first year I was "allowed" to fast, I became so ill with hunger that sometime during that long afternoon, I ate part of a candy bar I found buried in the sandbox behind our synagogue, and spent the rest of the night throwing up.

Personally, I'm much more able to feel spiritual when I'm well fed, well rested, and centered.

Jews wish one another an easy fast in honor of Yom Kippur. Since I don't fast--and since I hope those of you who are actively dealing with an eating disorder are not fasting either--I will wish you instead a day of contemplation, of connection to yourself and others, and a refocusing on your true appetites, whether they are spiritual, physical, emotional, or creative. Whatever your concept of holiness, I hope you can find some corner of it today.

To help you along, here's a gorgeous recording of Jacqueline du Pre playing Kol Nidre, courtesy of my friend Kay.

Scared straight?

These kind of scare tactics are, after all, the logical extension of the "war on obesity."

Only the author of this little news item is forgetting something rather important: food and cigarettes don't play the same role in a human being's life. You can live (much better, thank you) without smoking. You can't live without eating.

So what, exactly, is this fear-mongering supposed to accomplish? How about a new generation of disordered eaters? Oh, right, we've already got that. So . . . what's left? A new diagnosis for DSM-V--cibuphobia?*

*Cibus = latin for "food"

For all the perfectionists out there . . .

I believe this with all my heart.

If you never fail, you aren't living.




**Thanks, Shander!

New research study

If you struggle with binge eating disorder and live in the Boston area, this study might be of interest. You've got to be between 18 and 50 years old and a non-smoker, at least for the last six months. For more details, see the study posting.

I'm a fan of taking part in research studies-IF they offer you something useful.

For information contact Miguel Alonso-Alonso, malonso@bidmc.harvard.edu.

Just when you think you've seen it all . . .

comes this appalling cookbook, Hungry Girl, which touts itself as offering 200 recipes under 200 calories each.

The title says it all, to my mind: Hungry girl. Is that what we're aiming for here? To make sure girls stay hungry? Not to mention malnourished, obsessed, and generally distracted from more important matters?

Just think of all that women could achieve--women, not girls--if they weren't hungry all the time, or thinking about food, or worrying about what they're eating or not eating.

Imagine.




**Thanks to Katie Dummond.

"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.