New Zealand Radio

ran a nice interview about Brave Girl Eating. You can find it here. The lovely New Zealand accents don't hurt either! :)

Just in case you were confused about the nature of eating disorders . . .

read this, which is circulating on Tumblr. My younger daughter sent it to me. Wise girl.

OT: Veterans and mental health

Indulge me in a slight change of subject this morning, to the very real problem of health care for veterans. Specifically, mental health care.

It's well known that veterans who return from war struggle with a slew of mental health issues. And it's very well known that suicide is a major problem among active-duty personnel and vets, as this editorial in the New York Times points out. There were more than 295 suicides last year among active-duty soldiers. Kudos to President Obama for at least starting the process of, as he put it, "destigmatizing the mental health costs of war."

But we need to ramp up the conversation. We need to keep talking about the issue of war and mental health. We need to acknowledge that war damages people, that veterans struggle, and we need to do more to help them once they've done the dirty work of fighting for us. This blog explores some of the issues. Please take a minute to visit and leave a comment, and tweet the link to the blog. It's time we talked about it.

Book giveaway: We have a winner!

Actually, we have two winners, because I couldn't bear to choose just one.

Madz and Psychocat, you have each won a copy of the UK edition of Brave Girl Eating. Congratulations! Please email me your snail mail addresses to harriet at harrietbrown dot com.

Thanks to everyone who left a comment. I'm sorry I don't have enough books to give away more.

Book giveaway!

To celebrate the U.K./Australia/New Zealand publication of Brave Girl Eating, I'm giving away a copy of the book.

To enter, leave a comment on this post and tell me why you'd like to read the book. (Or, if you've read it already, what you liked about it.) I'll choose a winner at random this Wednesday, June 29.

Good luck!

NAMI in NYC, July 14

Just a quick note to let you know I'll be speaking at a NAMI event about eating disorders on July 14 in New York City, along with filmmaker Jesse Epstein. The NAMI page has a link to the event flyer, but warning: it contains potentially triggering images. So I've put the details below. I hope to see you there!


Where: NYU Langone Medical Center, 550 First Avenue (between 32nd and 33rd Streets, Smilow Seminar Room
When: July 14, 6 p.m.
RSVP: 212.684.3264 (but I think you can show up without RSVPing in advance)

I need your advice and wisdom

As you no doubt know if you're reading this, I've let this blog languish for a long time now. Too long. I won't go into the reasons for that lapse here, but I do beg your forgiveness. And so it's fitting that for my comeback post, I'm asking you for advice.

The advice isn't for me but rather is for a woman I'll call Mary, who's in her mid-30s and has been ill with anorexia since she was a teenager. She's been through in-patient, residential, intensive outpatient, outpatient treatment--you name it, she's been through it. And she is still sick.

Mary is smart and motivated. She understands what she has to do to recover: she has to eat. As for everyone with anorexia, eating is terrifying for her. Those of us who have re-fed a child or teen or young adult with anorexia know how very hard it is for someone with the illness to eat, and how much they need someone to stand with them and stand up to the eating disorder. Mary wants that very badly. She doesn't want to die. She wants to recover and knows, at this point, that she can't do it eating on her own.

Mary's dilemma has made me think long and hard about the need for a different level of care. I think one of the reasons FBT (the Maudsley approach) is successful most of the time is because parents care about their children in a different way than, say, administrators or caregivers at a residential facility care about their patients. I've come to believe that that love is part of the cure, maybe because it motivates parents to hang on through the toughest moments, or maybe because it's part of what breaks through the cognitive distortions of the illness. It doesn't matter why, really.

So I wonder: What if we created something like halfway houses for refeeding people with anorexia? Not residential facilities, with their (perhaps necessary) rules and restrictions and inevitably institutional feeling. More like a small house, with 3 or 4 people living there and round-the-clock nurses who developed real relationships with their patients. Who really cared about them. Who were capable of empathy and affection and, yes, maybe even love sometimes. There wouldn't be hours of group and individual therapy, because those things really don't help people until they're more or less weight-restored, so the cost could be much lower than the one to two thousand dollars a day cost of residential care.

What I'm really talking about is a kind of foster re-feeding home. I've given a lot of thought to inviting Mary to my home and re-feeding her, but there are some logistical challenges involved that I'm not sure are solvable.

So I put it to you: Do any of you know of resources for someone like Mary? Resources I'm perhaps not aware of? And what do you think of the idea of creating refeeding homes for people with anorexia?

I'm eager to hear from you. So is Mary.

Honor National Eating Disorders Awareness Week with Project BodyTalk

The last week of February is National Eating Disorders Awareness Week, a week-long way to raise awareness of eating disorders, the devastation they cause, and hope for the future.

This year's theme is "It's Time to Talk About It," a notion I love because I'm all about talking about it, whatever "it" may be. Secrecy perpetuates bad feelings--let's get all the "its" out in the open. So I'm excited to be partnering with the National Eating Disorders Association to use that week to raise awareness and get people thinking in new ways--not just about eating disorders but about all of the crazy, disordered attitudes toward food and our bodies we hold in this country. This year I'm doing my part through Project BodyTalk, a web-based audio project I started two years ago to give people a place to talk about their relationships with food, eating, and their bodies.


If you're anywhere near the Syracuse, New York, area the last week of February, you can come to one of our open recording sessions. We'll put you in a private studio and let you record a commentary. You can choose to be anonymous, use a first name, or use your whole name. You can talk about something you love about your body, something you've struggled with, something you want other people to know about eating disorders--it's up to you. I'll be posting details on the sessions soon, but I expect they'll be held on campus at the Newhouse School, 3-8 p.m. every day that week. (Contact me for more info as the time gets closer.)

If, like most people, you don't live anywhere near Syracuse, or you can't make it to one of our sessions, you can still do your part by recording a commentary and sending it my way. Listen to some of the incredibly powerful and moving commentaries on the site for inspiration, and then make your own MP3 or MP4 file, or use a CD, and send it in through this handy web submission form. You can also hear an NPR program on Project BodyTalk here.

I hope you'll join me and Project BodyTalk this week for National Eating Disorders Awareness Week. Because you know what? It's really freaking time to talk about it.

San Diego Conference

I'm sitting in the San Diego Airport, having gotten here at an ungodly hour for my flight back to NY. But I don't mind, because yesterday's Maudsley Parents conference was a great success.

The conference sold out, and our room was packed with a dynamic mix of clinicians and families.
The always cerebral Dr. Walter Kaye opened the conference with a friendlier-than-usual exploration of the neurobiology of eating disorders. Next up was Dr. Daniel leGrange of the University of Chicago, who took us through the history of research on eating disorders (distressingly meager) and explained in great detail the history of family-based treatment.

After lunch, we heard from Dr. le Grange and Dr. Renee Hoste, also of the University of Chicago, on clinical applications of the research. Last but not least, Roxie Rockwell of University of California-San Diego explained UCSD's wonderful week-long multi-family intensive program. (All PowerPoint slides are up on the Maudsley Parents website.)

Kudos to the main conference organizer, my partner-in-crime at Maudsley Parents, Jane Cawley, who by now really knows how to put on a great day.


And thanks to everyone who participated and attended. We're thinking New York City for our next conference. Stay tuned!

Dr. Sharma, I love you

I love you for acknowledging what many of us know to be true: that people metabolize calories differently, that yo-yo dieting screws up people's metabolisms and causes weight gain in some people, and, most important, that shaming people inspires not healthy behaviors but self-destructive ones.

But don't take my word for it. Read this interview with the University of Alberta's Dr. Arya Sharma yourself.

I love the fact that, as this story from the CBC news points out, Sharma is the chair of obesity research and management at the University of Alberta and is still "no fan of most diets." And I love this quote from Sharma:

We keep hammering home the stereotype of the fat, lazy slobs who are eating fast food all the time who are not moving, not exercising or not taking care of themselves, making poor choices, when there's very little science that actually backs this up.

Thank you, Dr. Sharma, for saying it so plainly, so matter-of-factly, so clearly. I hope someone's listening.


*Photo © CBC.

Obesity and eating disorders: they're connected

When I talk with doctors about eating disorders, I often end my presentation with a caveat to them, to be aware of how the current
"war on childhood obesity" can trigger eating disorders in those who are vulnerable. That's the point in the program where I often see one or two audience members sit back and cross their arms in a way that telegraphs plainly their disbelief and even disgust. (I've had people walk out at that point, too.)

If you think that's pushing things a bit too far, I'd like to call your attention to just one of the many "anti-childhood-obesity" websites I've run across lately. This one is particularly egregious, as it offers up cartoon characters that are both offensive and poorly illustrated (not to mention an obnoxious soundtrack, which you can turn off at the lower lefthand corner of the screen). The "cast" of characters here includes O-Bee-Sity, described herein as "s "the supreme fat lord of the universe" who can "turn kids into globs of fat with one slimy touch"; Phat Cells, which "have the ability to multiply and wreak havoc on the human body"; and--rather unbelievably--Anna-Rexia, who apparently hails from the planet Bulimia (don't these folks get the difference?) and both "infects little girls with eating disorders" and "despises" the rest of the cast (shown above).

Aside from the bad art and wild overuse of copyright symbols, there's some just plain bad information here. The site claims that childhood obesity causes not just diabetes, high blood pressure, and heart disease (all of which is still up for discussion, especially given the fact that we don't know whether obesity causes these ailments or whether the ailments themselves contribute to obesity), but also cancer, liver disease, asthma, and eating disorders.

Hello? Considering the fact that one of the "characters" here is "Dr. Smart," billed as the "secretary of health and fitness at the Pentagon," I'd like to think that someone was actually doing some research and not just spewing ill-founded and unsupported opinions as facts. Sadly, this is not the case. And I'd have to say that this is the norm for sites like this, which remind me of other zealous-but-ignorant campaigns.

In fact, as readers of this blog probably know, it's not obesity that causes eating disorders, but rather a combination of factors, mainly genetics and dieting. It's the war on childhood obesity--and on adult obesity--that's responsible for triggering anorexia, bulimia, and other eating disorders, not the condition of obesity itself. And the prejudice and stigma directed against the obese is likely responsible for many of the negative health outcomes we associate with weight.

Any way you look at it, websites like this one are not just ignorant or misguided; they're dangerous. And that's why I'll keep sounding the alarm when I talk to doctors. They need to know the consequences of their crusades.

Project BodyTalk on 51% this Thursday

I'm delighted that the talented Susan Barnett, host of the nationally syndicated NPR show 51%, will be airing a segment this Thursday, January 6, on Project BodyTalk. This audio and web-based project collects commentaries (a la StoryCorps) on issues relating to food, eating, and bodies. This show includes a lively conversation between Barnett and myself, as well as clips from several audio commentaries made last year by faculty and students at the S.I. Newhouse School of Public Communications. You can hear the full commentaries on the Project BodyTalk website.

Here's a list of NPR stations that carry the show. I hope you'll tune in, and then visit the website to listen to more commentaries and upload your own.

Thanks to my amazing grad student from last year, Megan Swann, who took the photo above and created the website.

5 New Year's resolutions worth making

I'm ready for the rash of media stories about New Year's resolutions with my own list of 5 resolutions that are truly worth making. Read all about it over on my Psychology Today blog.

Fat Body (In)Visible

Kudos to fat activist Margitte Kristjansson, whose new video, "The Fat Body (In)Visible," is a compelling look at the world of fat acceptance and what it's like to be a fat woman in America today. Watch it below, and then leave Margitte a comment at her blog, Riots Not Diets.

fat body (in)visible from Margitte Kristjansson on Vimeo.

White Plains tomorrow!

My apologies for not keeping up with the blog. Between full-time teaching and lots of travel for the book, it's been a challenging few months. But I promise more posts coming soon.

In the meantime, if you're in the White Plains, NY, area, consider coming out tomorrow night to hear the fabulous Dr. Evelyn Attia (pictured) and me talk about teens' relationship with food. Dr. Attia is a wonderful, smart speaker and I expect an exciting event.

Details:
New York Presbyterian Hospital
21 Bloomingdale Road
White Plains, NY

6:30 p.m.

Free!

See you there!

Maudsley Parents conference: San Diego, Jan. 21, 2011

For those of you on the West Coast (or those who wouldn't mind a sunny interlude in January), Maudsley Parents is pleased to announce that registration is open for our next conference, scheduled for Jan. 21, 2011, in San Diego.

The fabulous lineup for this one-day conference includes a talk on the neurobiology of eating disorders by Dr. Walter Kaye of the University of California-San Diego; a talk on family-based treatment (FBT) by Dr. Daniel le Grange of the University of Chicago; an interactive session on FBT by Dr. le Grange and Dr. Renee Hoste, also of University of Chicago; and a dynamic presentation on multi-family treatment for eating disorders by Roxanne Rockwell, the lead therapist at the University of California-San Diego's Eating Disorders Program. I've worked with all of these professionals, and they're amazing. I'll also be doing a reading from my book, Brave Girl Eating.

Register before November 30 and get the early bird rate of only $60 for a day full of education (and lunch!). For more information, click here. Hope to see you in San Diego!

Reviewers wanted

One of the most dispiriting aspects of book publishing these days is the disappearance of outlets for reviews. Once upon a time there were hundreds of newspapers that ran book reviews. Today there's just a handful. The result is that many, many books get no reviews in the mainstream book reviews.

I've been lucky to have Brave Girl Eating mentioned in a couple of magazines. Thanks to those editors! And a number of bloggers have reviewed it too, and I am grateful. Thank you!

Still, reviews are important to people considering buying the book, and so I'm asking you, dear readers, if you would consider writing a review of the book on Amazon.com if you haven't already. The book has been doing reasonably well and I'd love to see that momentum continue. New reviews help, believe it or not.

You have my eternal gratitude. :)

Another brave girl eating

There are many roads to recovery from an eating disorder. Unfortunately, they're all hard roads. Some are longer, some are shorter, but all of them are steep and scary and require immense courage and persistence and support.

Which is why I find myself so moved by the story of Sofia Benbahmed, a young woman who's fighting through a long recovery made even longer by the fact that her insurance company refuses to cover her treatment. When I look into Sofia's face, I see my own daughter--the same spark, the same hope, and the same terror.

Please take a minute to read about Sofia and her struggle, and help her if you can--for all the brave girls out there.

Guest post: Shan Guisinger

In my book Brave Girl Eating, I wrote about one theory of the origins of anorexia: psychologist Shan Guisinger's adapted-to-flee-famine theory.

I'm very pleased to have Dr. Guisinger writing about her theory on the blog today. I think it's a fascinating concept that deserves further thought. Please write in with comments and questions.

_____________________

Dear Harriet,

I’m happy that you described the adapted-to-flee-famine explanation for anorexia in Brave Girl Eating. I have found that it helps patients understand and fight their urges to restrict food and compulsively exercise.

The adapted-to-flee-famine hypothesis (2003) states that the distinctive symptoms of ignoring hunger, hyperactivity and denial of starvation were evolutionary adaptations that once helped starving hunter-gatherers make a last ditch effort to find better foraging grounds. This theory is supported by data from genetics, molecular biology and neuroimaging, yet eating disorders experts turn away from evolutionary explanations saying “we can never know for sure.” In fact, we regularly use circumstantial evidence and evidence based on probabilities to come to conclusions in science, the law, and in our lives.

For example, the criminal justice system has careful rules for evaluating circumstantial evidence because criminals rarely come forward to confess their crimes. Suppose someone were murdering teen-aged girls in your town. You would expect the police to arrest a man who had blood from the victims in his car, and you would expect a jury to convict him if the police found the murder weapon with his fingerprints, and if he had no alibi for where he was when the murders took place. How would you feel if the police let him go asserting that, without a confession, “we can never know for sure?” We would also be shocked if the judge let him go because he didn’t accept evidence based on probabilities, such as the DNA and fingerprint data.

This issue is not simply academic jousting. According to NIMH, the mortality rate for anorexia of 5.6% per decade is twelve times higher than the annual death rate due to all causes of death among young women between the ages of 15 and 25. And treatments based on the conventional assumptions have a dismal success rate. In fact McIntosh and colleagues found that patients in what was supposed to be the control group, given only nutritional counseling and emotional support, did better than those given cognitive-behavioral or interpersonal therapy which assume that anorexia is caused by psychological issues.

What is the evidence for the adapted-to-flee-famine hypothesis?

First, anorexia is now accepted as genetic. Although rare in the general population, if one identical twin has it, there is a 50% chance the other will develop it. Studies comparing identical and fraternal twins found that the increased risk is due to genetics and not to family environment. Moreover, the lack of long-term success of weight-loss programs demonstrates that without anorexia genes it is very difficult to maintain weight at 15% below normal. What anorexics do is physiologically and psychologically remarkable.

Second, denial of starvation and body size overestimation are demonstratively the result of unconscious machinations at the neuronal level. Brain imaging shows that the brain alters the reality that an underweight anorexic individual consciously perceives. When an anorexic looks at herself, her brain actively inhibits perceptual processing of visual input. This makes sense if the brain were trying to fool a starving person into thinking that she has the physical resources to travel.


Third, neuroendocrinologists have described the complex physiological changes that enable starving people with anorexia to feel like running for miles and refuse food offered. When leptin, a hormone that tracks fat stores, falls below a critical level, it activates neuronal circuits that reduce food intake and increase activity (Muller, 2010). Chen and colleagues (2004) have identified the gene, SIRT 1, that turns on hyperactivity in starving mice.

Natural selection is the only process that can produce such a network of specialized abilities, but ED researchers explain them as the result of a hodgepodge of biological breakdowns. Each favors a different dysfunction, for example, excess serotonin, impairments in set shifting, errors in reward pathways, and breakdowns in sensory integration.

The idea that biomedical dysfunctions are responsible for anorexia nervosa does not stand up to logic. For a person to develop the standard presentation of anorexia (difficulty eating, hyperactivity and body image distortion) at least three different accidents would have to happen together. The likelihood of this is very small. Moreover, the fact that the crucial biological changes of anorexia normalize with weight restoration indicates that they are a response to very low body weight, and not the cause.

In your book you eloquently describe how hard it is to recover from anorexia. It matters why people with anorexia feel they must restrict food and exercise. It matters in order for treaters to understand and help their patients; it matters to the person with anorexia to make sense of her experience of difficulty eating, drive to move, and body image. Treatment is often ineffective because, still today, most patients, therapists and doctors believe that anorexia nervosa is caused by the patient’s willful refusal to eat due to a need for control or to trying to be model thin. Their false belief is the result of the mind’s automatic attempt to make sense of anorexia’s puzzling feelings and behaviors.

Realizing that their bodies are trying to migrate helps people with anorexia overcome their anorexic urges; and, it helps their loved ones and their therapists to understand their struggle and perhaps support them in recovering their health.

Sincerely,

Shan Guisinger, PhD
shan.guisinger@mso.umt.edu

Family-based Online Bulimia Study

Hi y'all,

Please pass the word about the study below. I'm thinking it could be wonderful treatment for the right families. University of Chicago is at the forefront of research on ED treatment, and I trust their protocols completely.

************************************

The University of Chicago is conducting a research study designed to examine the efficacy of an Internet-based program for parents with adolescent children who show early signs of bulimia nervosa. We are seeking families who have an adolescent (ages 12-17) who engages in binge eating (large amounts of food in a short period of time) and/or compensatory purging (e.g., vomiting). Participating families will use an Internet-based program to address their adolescent’s eating disorder symptoms.

To be eligible:
* Families with an adolescent child (ages 12-17)
* Adolescent demonstrates eating disorder symptoms

For information call:
Colleen Stiles-Shields at 773-834-5677 and mention your interest in the Family Internet-based Early Bulimia Nervosa Study

or e-mail Jocelyn Lebow:
jlebow@yoda.bsd.uchicago.edu


or, to learn more, or to register online, visit:

http://epathprogram.org