Why I believe in fat activism

Scene: Meeting of my university's diversity committee (of which I am a member), where we have been planning a day-long diversity workshop for our faculty. Much conversation over who will be resistant to such a workshop, who is resistant to the idea of diversity in education in general. Much conversation in general over issues of cultural competence, etc.

The conversation turns to the current crisis in Haiti.

Professor Y: Some of the coverage on this has been unbelievably racist.

General agreement around the table.

Professor Z: Pat Robertson is talking about those "colored" people making a pact with the devil. And Rush Limbaugh, too. It's unbelievably offensive.

Professor X: Yeah, especially for a fat white guy like him!

Beat.

Me: Did you say "fat white guy"?

Professor X: (to his credit) I just caught myself.

Cut.

At the Y

She was there again this morning, in the vigorous Zumba class I take most Sunday mornings. I love this class because it's fun--exercising to blaring Latin music, following an instructor who shows rather than teaches the moves. I also love it because there's such a wide variety of ages and body types represented, from the hunched-over 70-something woman to 10-year-olds with their mothers. The women in the class--and we are women, although men are welcome--range from thin to fat. Each of us moves to the best of her ability. There are good dancers and bad dancers in the class, and it's all OK.

There are plenty of thin women in the class, but the woman who turned up this morning--second time I've seen her in class--is far thinner than anyone else. Her close-fitting black leggings reveal the shape of her femurs where they meet her jutting hipbones. Her arms look like they might snap at any moment. Her face has a look I've come to recognize, a driven look that also conveys flatness, a certain kind of despair.

You can't tell whether someone has an eating disorder from looking. But I'd bet a year's salary that this woman has anorexia.

Last time she turned up in the class, I went out to the front desk afterward and asked if the Y had a policy about people with eating disorders or whose health was compromised in other ways taking vigorous exercise classes. Shockingly, they do not. I explained my concerns to the woman at the desk, saying I was afraid this ill woman might collapse in class. Or worse. I hoped I wouldn't see her again.

But there she was this morning. In a sweltering room, she wore leggings and a sweatshirt zipped to her chin. I watched her exercise in the mirror; she didn't know most of the steps, being new to the class, but she threw herself into the dancing with determined force. She was burning calories. I couldn't tell if she was having fun. Most women in the class smile through much of it, but this woman's expression never changed.

I'd thought at lot about her since the last time I saw her in class, and decided I would try to talk to her after class, befriend her, get to know her. Only this time, like last time, she ducked out of class before the end. I glimpsed her on one of the elliptical machines on my way out, and wondered how many hours a day she spents at the Y.

I was struck recently by a quote in this film, made by documentary filmmaker Hope Hall about her mother, who's struggled with anorexia and bulimia for many years. The film includes a voiceover phone call between Hope and her mother, where her mother says, "Through all my growing up, through all my marriage, I was always trying to measure up, trying to be somebody else. And all of a sudden, you said, 'I just love you. I don't need you to be well.'"

I think about the woman at the Y, and am torn by what I wish for her. I hope she people in her life who just love her. But I also wish that she, and everyone with an eating disorder, had people in their lives who could help them get well. Who could help them out of the private hell of anorexia and bulimia and into a life filled with something besides starving and binging and suffering.

I hope the woman does not come back to class, because, selfishly, I am uncomfortable seeing her there. In her gaunt face I see the face of my daughter, Kitty, at her sickest. I imagine Kitty at age 40, living this kind of hell, and I feel sick.

I wish I knew what I could do to help.

A difficult childhood = health risks?

I know from my own experience that childhood traumas can turn into psychological issues in adulthood. Now new results from a long-term study in California suggest that certain kinds of childhood traumas can translate into other kinds of health risks.

As reported in Time magazine, researchers at Kaiser Permanente have found correlations between certain kinds of traumatic events in childhood--sexual, physical, and emotional abuse--and elevated risks of heart attack, stroke, depression, emphysema, and, yes, my favorite bugaboo, obesity.

Here's a quote from the Time story:

"For the past several decades, the ACE study has recorded reports of negative childhood experiences in more than 17,000 patients. Adverse experiences include ongoing child neglect, living with one or no biological parent, having a mentally ill, incarcerated or drug-addicted parent, witnessing domestic violence, and sexual, physical or emotional abuse. . . . Compared with a person with no adverse childhood experiences, or ACEs, a person with four or more has almost double the risk of obesity. Having four or more ACEs more than doubles the risk of heart attack and stroke, and nearly quadruples the risk of emphysema. The risk for depression is more than quadrupled. Although many of these outcomes could reflect the influences of genes and other environmental influences — beyond those occurring in childhood — the tight relationship between increasing ACE numbers and increasing health risks makes the role of child trauma clear."

Some of these correlations seem straightforward, like the one between ACEs and emphysema, which can be explained at least in part by higher levels of smoking-as-self-medication. But this study takes the correlation a step further:

"Early adverse experience can disrupt the body's metabolic systems," says Dr. Jack Shonkoff, director of Harvard's Center for the Developing Child. "One of the cornerstones of biology is that our body's systems when they are young are reading the environment and establishing patterns to be maximally adaptive." Researchers also posit that high levels of stress hormones caused by ACEs can wear down the body over time. A temporary spike in blood pressure in response to a stressful event may be useful to power an adaptive fight-or-flight response, but over the long term constant high blood pressure could raise a person's risk for heart attack and stroke. Studies have also found that consistently elevated levels of stress hormones, like cortisol, can lead to permanent damage in certain brain regions linked to depression.

Even more interesting, they suggest that such stress-induced physiological changes can be passed down through the generations through epigenetics, changes in the traits expressed by genes that don't come from mutations in DNA.

Fascinating stuff. What it suggests to me is yet another refutation of Cartesian dualism. What we think and feel and experience may shape us in more ways than we know.

What do you think?

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.