Check the Huffington Post . . .

for my response to the White House Task Force on Childhood Obesity.

Add your comments, please. I'm sure there will be plenty of the wrong kind up shortly.

Kudos to the eating disorders work group on DSM-V

for deciding not to make obesity a disease in the next edition of the Diagnostic and Statistical Manual of Mental Disorders.

This decision has significant ramifications for how docs treat and to some extent see obese patients. I'm a big proponent of changing the dialogue around obesity from a discussion of weight to a discussion of health. The two are not synonymous. I'm also hoping this will stop bariatric surgeons from marketing their surgeries as eating-disorder treatments, for instance.

The group also recommended changing criteria for anorexia and bulimia:
• Now patients must weight 85% of ideal body weight or less for a diagnosis of anorexia; in future, if the changes go through, the criterion will be "restriction of energy intake [leading to] markedly low weight." This rightly shifts the emphasis from the rigid weight characteristic to a pattern of eating and relationship with food. Now insurance companies will have a harder time cutting people off from treatment once they hit 86% of ideal body weight.
• Loss of menstrual period is no longer one of the criteria for anorexia. Some women never lose their period, no matter how thin they get; others keep menstruating even at very low weights.
• Bulimia will be diagnosable with purging episodes of once a week; right now, the criterion is two episodes a week.
• Binge eating is likely to become a diagnosable eating disorder.

New film: Fat

A filmmaker named Jennifer Jonassen sent me a link to this trailer for a new documentary, FAT, due out later this year. I think it looks pretty interesting. What do you think?

"You're so fat!"

The car was a beat-up sedan crammed with college kids--guys--who had clearly started their Saturday night partying on Saturday afternoon. My husband and I were out for a short three-mile bike ride. I heard the guys yelling and carrying on from a block away, and I knew they would yell something at me. And they did.

"You're so fat!"

As I pulled up alongside my husband, he asked, "What did they say?" When I told him, his jaw dropped.

"I can't believe they would say something like that!" he fumed.

I could. And as I told him, it didn't bother me all that much. I'm used to it. Guys have been yelling things at me since I was 15. Like any woman, I've learned to tune it out. It's a power trip, a form of misogyny, a reminder that women are vulnerable to men in a variety of ways.

Still, I thought about it all the way home. It reminded me of the way boys at my junior high school used to drop pennies on the ground, and yell "Kike!" at anyone who picked one up. And with that recollection, I realized viscerally, profoundly, and in a deeply emotional way that what those guys in the car were doing has a name: hate speech.

And although I've been thinking and writing and talking about this subject for years, I think this was the first time I truly got it in a fundamental way. And that is something I'll be thinking about for weeks to come.

Book trailer

A very talented student at Newhouse, Shelby Hadden, created this trailer for my forthcoming memoir, BRAVE GIRL EATING: A FAMILY'S STRUGGLE WITH ANOREXIA. Isn't technology great?

Let me know what you think.

One more reason NOT to get bariatric surgery

Bariatric surgery--the practice of deliberately mutiliating the gastric anatomy in order to lose weight--is being pushed harder than ever these days. The latest claim: it cures Type II diabetes instantly.

Not so fast. Apparently the issue is more nuanced than that. Researchers at the University of Washington recently found that people whose fasting blood glucose levels came down after having the surgery were still spiking diabetes-level glucose levels after meals.

The money quote:

"I don't think the procedure cures whatever it is that's causing diabetes in the first place," said Arthur Chernoff, MD, chair of endocrinology at Albert Einstein Medical Center in Philadelphia, who wasn't involved in the study.

SHocking, isn't it? Fat may not be the only cause of diabetes.

In fact, the weight-diabetes link is one of doctors' strongest arguments against fat acceptance and health at every size. Bariatric surgery is very serious business--and I mean that in both senses of the word. It's a multimillion-dollar industry based on the premise that it's a good idea to take out part of your guts--forever. Once you've had the surgery, your body is unable to process nutrients the way it used to. You may or may not become thin (some people lose weight only to regain it after); you may or may not experience some of the serious complications of the surgery; you will be permanently malnourished.

And now you may not have an instant cure for Type II diabetes after all. Because the equation may be a bit more complex than fat = bad, thin = good.

Bravo to Gawker

That sound you hear? It's me clapping for this tell-it-like-it-is piece from Gawker, which deftly skewers the mainstream media's not-so-hidden obsession with thinness.

My favorite quote:
The purpose of working out is get in shape. Not to get "thin." To be in shape, for the average person, connotes being healthy, and improving on the basic elements of one's own fitness: muscular strength, endurance, cardiovascular, flexibility, etc. . . . designing a workout and nutrition program with the goal of being thin will almost certainly ensure that you cannot achieve a high level of fitness; you would eat a low-calorie diet, thereby robbing yourself of muscular gains.

Note that I deleted a sentence or two in here. Even Gawker falls prey to the knee-jerk obesity-is-bad syndrome. (We really have to have a chat about that, Nick Denton.) But it's not so easy calling out the Gray Lady herself on the assumptions and obsession with thinness. So kudos to Gawker, and Hamilton Nolan, who wrote this post. Let 'em know what you think.

Fat and thin: It's all in your brain?

A new report from Brigham Young University suggests that women may be hardwired to worry about body image. Using functional MRI scanners, which record which parts of the brain light up while it's engaged in a task, researchers have discovered that women's brains react differently than men's to images of fat and thin. Study subjects, who were all thin, passed a screening test for eating disorders and so were presumed to have no overwhelming body image concerns.

When women were shown images of overweight women and told to imagine that someone commented that they looked like the woman in the image, a part of their brains that engages in self-reflection lit up. When looking at the images, says Mark Allen, a neuroscientist at BU, "women are actually engaging in an evaluation of who they are and whether they are worthwhile as a person. Even though women might claim to be well adjusted and not care about body issues, subconsciously they might care."

But couldn't this be the result of the overwhelming socialization American women experience on the subject of fat? Would the brains of women in a different culture--a culture that didn't put so much value on the thin ideal for women—light up the same way?

I'm not a neuroscientist, but I wonder if this study is flawed. Or maybe I simply don't want to accept that there's a biological limit to self-acceptance on this issue.

I'd love to hear what you think.

Britney does Photoshopping

Kudos to Britney Spears, of all people, for releasing some before and after photos of herself--before and after airbrushing and photoshopping, that is. She's the latest in a trickle of celebrities doing this. It's a commendable effort, even if, as Jezebel rightly points out, the before images are still unrealistic, thanks to makeup, lighting, and other props ordinary women don't have when they look in the mirror.

Still, it's a start, a small stone rippling the surface of the unattainable thin ideal. Me, I'm hoping for the rockslide. Any day now.

Health Care for the Obese

A new study published today reports that overweight and obese patients get the same or better quality of health care than "normal" weight patients.

Researchers at the University of Pennsylvania say they looked at quality of care across eight performance measures among Medicare and VA patients, and found no difference in the kinds of treatments doctors prescribed for obese and non-obese patients.

According to a s tory on MedPage Today, "Performance measures included diabetes care management (such as lipid and HbA1c monitoring and eye tests), pneumococcal vaccination, influenza vaccination, screening mammography, colorectal cancer screening, and cervical cancer screening." The story goes on to quote one of the researchers commenting that while doctors do "harbor negative attitudes" toward heavier patients, that prejudice doesn't affect the quality of care delivered.

I think this is a pretty grandiose conclusion to draw from such a limited study, and the researchers themselves cautioned against extrapolating these results too broadly. To me, the study raises some interesting questions: Are doctors more tolerant of overweight vets and/or poorer patients? Is "quality of care" strictly a function of which treatments are recommended?

I don't think so. I wonder what the patients would have to say about the quality of care they received--not just the treatment recommendations (which are of course important) but the relationship they had with their docs, and how it affects their long-term care. I wonder whether these two populations typically have long-term relationships with the same doctor, or whether they often see a revolving cast of medical providers, and whether that might make doctors react differently to them than to patients they see regularly.

Thoughts?

Warning: The Images You Are About to See May Be Damaging to Your Health

I'm a big fan of Jezebel, but I think they've got it wrong this morning. In a post discussing a recent editorial in the Daily Mail by grieving mother Rosalind Ponomarenko-Jones, whose 19-year-old daughter died of anorexia, Margaret Hartmann argues against the notion of labeling photos of celebrity "twiglets" when they get too thin.

Ponomarenko-Jones argues against the current appearance-driven culture, which calls out celebrities not for achievements but for appearance. And "calls out" is the right expression, since we're all familiar with the standard scary-skinny-celebrity story these days: Publish a photo of a woman so emaciated that it's painful to look at her, along with a headline that screams a fake concern for her well-being. The whole exercise feels prurient and voyeuristic.

Hartmann centers her argument on the logistics and legality of the question: How would we determine when a celeb is "too thin"? How would we know when to label an image and when not to? It's a valid point. And before commenters jump on me for this, I acknowledge that you can't tell whether someone has an eating disorder just by looking at her. Some people are naturally skinny, and there are other reasons (other illnesses) for gauntness.

But Ponomarenko-Jones has the moral high ground here, and I wish there were a way to honor the spirit of her request. Because we (and by "we" I mean the media) don't go around publishing photos of, say, recent cancer victims, who may be every bit as scarily skinny as an actress in the grip of anorexia. Yet magazines and websites are full of images of "twiglets," young women so thin you can see the shape of their femurs. Why is it OK to publish these images and not, say, images of Farah Fawcett as she lay dying of cancer?

It comes down to our blindness to eating disorders as "real" diseases. We would cringe at the idea of violating Fawcett's privacy in that way. Yet the young celebrities who walk so scary-skinny among us are dying of an illness, too, an illness that will kill them as surely as cancer killed Fawcett. The difference is that with treatment, many of these women can recover; for Fawcett and many other cancer victims, alas, treatment did not save their lives.


And of course treatment won't always help with eating disorders, either. But the point here is that instead of parading these images as models for women--whether this is openly acknowledged or not--we should label them for what they are: images of the gravely ill, who are struggling with their own terrible reality and heart-breaking health battles.


Jezebel got it wrong. The real shanda (as my grandmother would have said) is that we pretend there's no such thing as too thin.

Conference in Chicago--register now!

In just over two weeks Maudsley Parents will sponsor its second conference on eating disorders--this time in Chicago. This one-day conference, aimed at parents, therapists, and researchers, features some of the best thinkers on eating disorders in the country--including Dr. Daniel le Grange and Dr. Walter Kaye—plus a panel of parents who will talk frankly about what they know about combating their children's eating disorders.

It's going to be a fabulous event. I'll be there, along with my two partners in crime from Maudsley Parents--Jane Cawley and Ann Farine. We've worked hard to keep it affordable so everyone who wants to come can manage it.

For more information or to register, click here. We'd love to see you in Chicago!

Book Giveaway: 100 Questions & Answers About Anorexia Nervosa

Dr. Sari Shepphird is one of my favorite "experts." Shepphird, a clinical psychologist from Los Angeles who specializes in treating eating disorders, has a new book out, 100 Questions & Answers About Anorexia Nervosa. The book tackles the complex and confusing subject of eating disorders by posing and answering questions like "Are athletes at greater risk for developing anorexia and eating disorders" and "How do I know if I have a healthy body image?" The book is written for people with anorexia, their friends and families. I admire its clear, practical approach, and think it will be of great help to many.

And I've got a copy to give away! If you'd like to enter the drawing for a free copy of Dr. Shepphird's new book, leave a comment on this post telling me why you're interested in reading it. I'll draw names at random next Monday, March 29.

Good luck!

A troll among many trolls

I don't normally bother with trolls, but this one sent me an email to my work address that is so vile, I have to share it here with all of you.

Barry, I suspect you are what I think of as a self-loather. Maybe you were once fat. Maybe you're fat now. Maybe you're deathly afraid you will be fat in the future.

Personally, I love how you toss aside research in favor of your own baseless and warped opinions. That Barry, he sure knows better than those high-falutin' doctors who actually research this stuff!

Since you think shame is a good health-care strategy, I'll take your idea a step further and see if shame is a good strategy for curing haters like you. Probably not, alas.

I hope my readers will respond to you in the same spirit in which you wrote to me.



I was mystified and angered by your article in the Times today. Are you actually arguing that obesity is a healthy lifestyle? Are you really saying that fat people have no control over their food intake and amount of exercise? Eating too much is nothing to be proud of, just as drinking too much alcohol is nothing to celebrate. You are lying to yourself if you think you are not shoving far too many calories into your mouth. You're fat because you can't control yourself--it's that simple.

The reason we stigmatize obesity is because it really is a choice, unlike skin color, ethnicity and the religion you were raised in. Obesity is a signal to others that this fat person is living an important part of his/her life totally out of control. It signals a lack of self-discipline and a warped sense of self-worth. Your position on this means means you're proud of your lack of control about how much, and what, you eat. It's delusional to be proud and pleased that you are out of breath when you climb stairs, that you are heading for a horrible old age--if you live that long, that making love to your partner is a problem instead of a happy event, and that you can't perform simple tasks from properly wiping your ass on the toilet to picking up an earring you've dropped.

Delusional: For example, you state that the emotional stress of the prejudice against fat people causes the health issues that result from obesity. That is not science, that is nonsense. We know stress can be a contributing factor to poor health, but you're trying to blame others for the conditions you create by eating too much. Reminds me of alcoholics saying they drink too much because of all the pressure on them to stop drinking.

On the one hand you blame doctors for relating to obese people differently than normal weight folks because, as you say, doctors believe fat patients won't follow orders, won't show up for appointments etc. Then later in your article you say fat people don't show up for doctor appointments because they feel bad about themselves and worry about how doctors will relate to them. Doctors know from experience that fat people miss appointments and can't or won't take care of their own health. Of course they relate differently to people like you who disdain main stream medical advice.

When Lincoln University tried to help fat kids get well and avoid incipient heart and other diseases, you condemn them for their efforts. What you fail to understand is that your stance actually kills people by making gluttony and self abuse through food a good choice, a choice to be proud of. What you are doing diminishes the real harm of prejudice which punishes innocent people for the color of their skin or their ethnicity--things they can't and should not want to change.

But obesity is a lifestyle choice, like smoking and alcoholism, a self-destructive lifestyle choice that harms the people who choose to follow that course. Anyone can get thinner and improve their overall health. It is not easy but rarely are the important life choices easy. That doesn't make your choice a virtue. It is difficult to diet and exercise on a regular basis and change your attitude about stuffing as much food as you can into your face. We've all heard the reasons people live your way, and none of them are good, abuse as a child, the comfort derived from eating lots of fatty creamy things, the hit of sugar, the bad habits of a deprived upbringing blah blah blah. We rightfully despise drunks who abuse themselves and others, ruin careers and the lives of those who love them. Similarly obese people are wearing a big sign that says "it's all about me and screw you who object to my overeating, it's costs to society, it's bad example to young people, it's strong signal that I'm out of control. I do it because it feels good and I'm proud of that." This is called selfish and irresponsible--nothing to be proud of.

Think about the damage your article has done. Making a virtue out of a lifestyle that any scientist, medical person or just plain educated folks know is harmful. Shame on you.
Barry XXXX
NY

PLEASE NOTE: THIS THREAD IS NOW CLOSED.

The stigma of obesity

I'm delighted that the New York Times has run this piece, even though they cut the fabulous Marilyn Wann from my final draft.

Let me know what you think. And if you're feeling brave, venture on over to the New York Times' blog discussion of it. It's a stunning example of how deeply ingrained fat stigma is in our culture. Sheesh.

And a big welcome to Jezzies who land here. Love the photo of Gabby that ran with the post today.

Protest in D.C. today

If you're in Washington, D.C., today, check out this protest against the insurance industry. Activists plan to "arrest" health insurance execs who are there for a meeting, and hold a rally afterward.

The idea behind the event, according to Gerald McEntee, president of the American Federation of State, County, and Municipal Employees (AFSCME), is "to expose the high crimes and misdemeanors perpetuated by the insurance industry time after time and year after year, and we are totally sick of it. We're going to crash their party and put an end to its injustice."

I'm with you in spirit!

The U.K. tackles body image issues

Kudos to the Royal College of Psychiatrists across the pond for taking on the thorny issue of media and body image in a powerful way.

The U.K. group just issued a statement admonishing the media for their damaging portrayal of eating disorders. That's good, and it goes along with similar statements made recently by several U. S. groups. Raising awareness on both sides of the pond--excellent work.

The RCC's gone a step further, though, calling for a "new editorial code" that would end the promotion of the unattainable thin ideal in the media. This is a bold step, and I'm going to be following developments closely on this subject.

The RCC identified three main areas of concern (and I'm quoting here from its press release, as you can no doubt tell from the Anglicized spelling):

Visual imagery: Preteen or underweight models are used by the media and advertising companies to promote a thin body ideal, and airbrushing and digital enhancement is widely used to portray physical perfection that is unattainable in real life.

Unbalanced articles : Many magazine articles give advice on dieting without giving information about the long-term effectiveness of diets and the dangers of extreme dieting. ‘Body critical’ articles also target celebrities for being overweight, underweight or physically imperfect, which normalises body criticism and can make people dissatisfied with their own bodies.

Inaccurate portrayal of eating disorders: Many articles ‘glamorise’ weight loss and portray eating disorders as mild disorders or personal weaknesses, rather than serious mental illnesses requiring specialist treatment.

I'm expecting cries of First Amendment foul on this side of the pond. It raises an interesting dilemma for me, as both a magazine journalist (and professor of magazine journalism) and an eating disorders advocate. Is censorship ever a good idea? How about self-censorship, which I think is what the British shrinks are suggesting?

My journalism colleagues will no doubt want to throw me off the island for saying this, but I'm all for some kind of self-censorship in this case. No journalistic standards will be violated if, for instance, magazines ran images of beautiful 20-year-old American models instead of emaciated Russian preteens with preternaturally pouty lips. In fact, I could argue that in the best possible tradition of journalism, magazines have a responsibility to tell both sides of the story: Instead of blaring the trumpets of weight loss at any cost, how about stories that encourage women to accept and love themselves as they are? I'm not even gonna mention the kind of cognitive dissonance that comes from Photoshopping the hell out of Kelly Clarkson on the cover and then running a feature quoting her as saying she loves her body the way it is and doesn't feel the need to diet herself into oblivion. I'm not even going to mention the magazine that did this (cough, rhymes with elf).

When I pitched a story on self-acceptance and body image recently to a magazine that shall not be named (cough, rhymes with wealth), I was told by my editor, rather sadly, that it would never fly.

Maybe when pigs grow wings.

**Thanks to one of my students, Courtney Egleston, for posting this story originally on the Newhouse magazine feed.

Jezebel investigates MeMe Roth!

Check out this awesome post by Jenna over at Jezebel, who as far as I can tell is the only journalist who's actually bothered to investigate Roth's pseudo (cough fake) credentials for her ridiculous one-woman anti-obesity campaign.

As a professor of journalism and writer for mainstream media outlets, I'd love to know why no one else has even questioned Roth's patently false claims and unsupported stance. How about Nightline, which pitted Roth and a chick named Kim Bensen against Marianne Kirby and Crystal Renn in this "faceoff" questioning "Is it OK to be fat?"

I can't help but think this is a) an example of how sloppy some journalists are getting, and b) a function of the widespread fatphobia washing through the culture.

Either way, kudos to Jezebel for doing some actual reporting. And, of course, presenting that reportage with the requisite levels of snark and sarcasm.

The Woman at the Y, part 4

She was back again. The woman at the Y. I thought I was ready. I'd talked to myself about it. I'd told myself, It's her business, it's her life, I don't know her story, and anyway, there's nothing I can do. So when she took up a position right toward the back of the room this morning, I made myself look away from her in the mirror. I did OK.

But five minutes later, I looked at the mirror and she had somehow moved up in the class. She was now directly behind me, close enough to once more see the shape of her thigh bones through her pants, see the strained and straining look on her face. When the song ended I moved across the room, to a spot where I couldn't easily see her. I thought I was doing OK.

And she took off her shirt.

Understand, this is not a class where people take off their shirts or exercise in their sports bras. I've never seen anyone else do that. Not that there's anything offensive about the idea of working out in a sports bra; it's just not the culture of this particular class. So her action would have been startling no matter who she was or what she looked like.

Now everyone could see the shape of every rib, count the knobs of her spine, consider the impossibly small diameter of her waist.

I fled. I ran out of the room clutching my water bottle and sat in the bathroom of the Y and cried.

I'm sure at this point that she knows that her presence disturbs me. As a friend later said, it's as if she's a specter, haunting me. As if I needed haunting. As if I needed reminding of everything anorexia has taken from the people I love and care about.

I won't be going back to that class.

Comments have been disabled on this blog post only.

Why Dick Cavett needs a muzzle. Or maybe a gag.

I used to like Dick Cavett. Of all the talk show hosts, he was the one known for his erudition, his intellectual streak. Johnny was the funny one, but Dick was the insightful interviewer, the one who came up with the best questions, whose show made you think.

I haven't been a fan of Dick's in a while, ever since he wrote this truly obnoxious blog post on obesity. Cavett's not the only painfully thin celebrity to weigh in (ha ha) on the subject, and he won't be the last. But his blog post seemed especially egregious to me, maybe because he wasn't responding to a current event, or an interviewer's question. He was just flying his fatphobic flag, loud and proud. By using words "heavily larded," "a herd of heifers," "the size of the Hindenburg," and other choice descriptors, Cavett showed off not only his vocabulary but his jejune perspective. (No, Dick, you're not the only one who knows fancy words.)

I thought I was over Dick Cavett. I really did. It's hard to stay pissed off at a washed-up ex-talk-show-host who's got nothing better to do than vilify people based on their appearance. Then he ticked me off all over again with a quote in this week's New Yorker magazine, in a piece by Ben McGrath on an odd little throwback of a recruitment video recently released by Yale.

McGrath quotes various Yale alums on the pros and cons of the video. Their comments are informative and amusing. That is, until we get to Cavett, who says, "“I wonder if it really was made in America, because there are no fatties.”

Really, Dick? That's your reaction? That the video features "no fatties"? What does that have to do with the subject at hand?

It seems that Cavett just can't put a lid on it; he's got to inject a little fatphobia into every conversation in print. Mercifully, there aren't too many of those, because, after all, he hasn't actually done anything worth mentioning in about 25 years. Maybe he's trying to line himself up a reality show. Maybe he wants to replace Howard Stern. Or maybe he's so obsessed with the subject of fat people that he literally can't help himself.

In which case, Dick, let me give you a few words of advice: Shut up already. You may have a high IQ, but your comments illustrate your ignorance, your prejudice, and your inherent lack of decency and kindness.

Come to think of it, maybe Rush Limbaugh has a co-host spot. Dick Cavett would be perfect for the job.