In honor of National Eating Disorders Awareness Week . . .

here's a wonderful short video to raise awareness and most of all hope. Because, as NEDA says, everybody knows somebody.

I wish you peace, hope, and recovery from whatever you struggle with.

Last chance!

Tomorrow is the last day to get the conference room rate for the one-day conference on child and adolescent eating disorders in Pearl River, NY, sponsored by Maudsley Parents. This fabulous one-day conference features some of the top experts in the field talking about how to recognize and treat eating disorders in children and teens:

• Debra Katzman, MD, will talk about where we stand with child and adolescent eating disorders
• Rebecka Peebles, MD, will talk about the medical side of treating child and teen EDs
• Katharine Loeb, MD, will talk about early interventions--what, why, and how
• Daniel le Grange will talk about working with families from both a therapist and parent perspective
• Evelyn Attia will talk about whether there's a role for medication in treating children and teens with EDs

This is going to be a truly remarkable conference, and I hope you can join me and my co-chair at Maudsley Parents, Jane Cawley on Friday, February 17, at the beautiful Hilton Pearl River hotel.

See you there!

What do YOU stand for?

Deepest thanks to the fabulous Marilyn Wann, who created the "I Stand for" project in response to Georgia's shameful Strong4Life campaign. I'm proud to be one of the many, many people who stand for something besides weight bigotry, shame, and stigma.

You can see the whole series on Marilyn's tumbler and facebook pages. They're a pretty inspiring bunch. If you'd like to participate, send your photo and "I Stand for" statement to Marilyn at marilyn@fatso.com.

This makes the Georgia campaign even more manipulative

According to a story today in the Chattanooga Times Free Press, the heavy children shown in the state of Georgia's shaming, shameful Strong4Life campaign are child actors hired to pretend they have hypertension, no friends, and other negative qualities the ads associate with childhood obesity.

Because . . . they couldn't find any fat children with those conditions who were willing to model for their ads?

Maybe. Maybe not. Here I was worrying about how starring in an ad like this would affect a child like "Jaden" or "Maritza." It turns out there is no "Maritza," or rather, "Maritza" is actually a healthy 11-year-old girl named Chloe who does not have hypertension, or any major health issues.

So it turns out that not only is this so-called public health campaign manipulative and shaming, it's also a big lie. A big FAT lie.

Stop lying, Georgia. Really.

Dear "Starving Secrets"

Editor's note: Today's guest post comes from 15-year-old Bridgette T. I'm impressed with this young woman's articulateness and determination and I think you will be too. And if you're not sure you agree with her, I suggest you google the show and click on "images."

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

Dear Starving Secrets,
I am a fifteen year old girl recovering from anorexia. This is currently my tenth week in an outpatient program. I began treatment in the program after my initial evaluation there resulted in me being sent to the hospital. I was in the hospital for sixteen days, though I never restricted during any meals except for my first one. I had to drink at least one Ensure every night, as my heart rate dipped into the 20s when I was asleep.

I’m not asking to be on your show. I’m asking you to reconsider it.

The title was the first thing that shocked me: Starving Secrets? Really? They’re making a pro-ana show?! Huh…that’s going to be pretty hard to stay away from…

Then I saw a commercial for it: What in the world? People with anorexia are being documented? If I were just a normal person and I found out that there was a show about people who were anorexic, and all I knew about anorexia was that it made you skinny-of course I would watch the show, to learn how they do it! How do they drop that much weight? I understand that the show also shows the negatives of eating disorders, but I don’t think kids are really going to take that into account. A big thing with eating disorders is the whole “It couldn’t happen to me” thing. At treatment, people are told that by not eating they are risking going to the hospital. Half of us already have gone to the hospital. Though vitals are tanking and we know that people have died from this disease, it doesn’t make people eat. Because you simply don’t believe it could happen to you, that you could be that girl whose funeral is on the local news because she starved herself to death.

Though this show may help inform some people, it’s also going to trigger many. Is it really worth the risk?

Sincerely,
Bridgette

What's wrong with Georgia's childhood obesity campaign

My Aunt Selma was a fat teenager. Like most fat kids, she was deeply ashamed of her body. She tried many times to lose weight, and eventually hit on two strategies: cigarettes and bulimia. She died in excruciating pain, in large part from the abuse she’d heaped on her body for many years. But she died—and lived—thin.

I think about Selma every time I hear about yet another new initiative to fight childhood obesity. The latest is Georgia’s “Strong 4 Life” campaign, which features black-and-white images and video clips of children talking about being fat. Several of the kids say they don’t like to go to school because they get picked on. One asks his mother dramatically, “Mom, why am I fat?”

The answer is implicit in the advice found on the campaign’s website: Eat less junk food and more fresh fruits and vegetables. Be physically active. Limit screen time. All great ideas, except that doing these things won’t necessarily make kids thinner. Over the last decade, dozens of school programs have used nutrition education, junk food bans, and farm-to-school projects to try to slim schoolkids. None have worked. They’re positive programs that support kids’ health. But they’re considered failures because they don’t reduce weight.

Like virtually every other effort to combat childhood obesity, the Georgia campaign suggests that obese kids and adults can get thin by making moderate lifestyle changes, a fact not borne out by research or experience. Rudolph Leibel, an obesity researcher at Columbia University, has demonstrated over and over how biology makes maintaining weight loss difficult to impossible for most people.

And like most such efforts, the Georgia campaign fails to take into account the connection between obesity and stress—specifically, the stress of being stigmatized over weight. When Jaden tells the camera he likes to play video games alone because other kids pick on him, the screen reads, “Being fat takes the fun out of being a kid.” The implication is clear: The problem is with Jaden. It is his fat, and the fact that he is fat, that make the other kids taunt him. The ad follows up with a taunt of its own: “Stop sugarcoating it, Georgia.”

Peter Muennig, M.D., of Columbia’s Mailman School of Public Health, researches the connections between weight and health. He believes stigma and weight bias are responsible for at least some, and possibly most, of the adverse health effects associated with obesity. In other words, it may not be weight itself that makes people sick, but rather the stress of being fat in a fatphobic society. Kortni Jones, a physician’s assistant in Michigan, looked at the relationship between weight stigma and health care in her master’s thesis, and found that messages of overt stigmatization from health-care providers translate to worse health care for people who are obese. Rebecca Puhl of Yale’s Rudd Center for Food Policy & Obesity has come to similar conclusions after doing a series of studies on how stigma affects obesity.

Clearly, shaming people about weight is not an effective public health strategy. So why are we still doing it? Why, for instance, is there nothing on the Georgia campaign website about educating kids not to tease each other over weight? Why do people who would never dream of telling a joke about blacks or Jews tell fat jokes without flinching?

Efforts like this one emphasize the idea that weight loss is a matter of personal responsibility, and they demonize fat children and teens in the name of helping them. How do kids feel when they see kids who look like them being targeted as not OK? They already know it’s bad to be fat; in one recent study, children as young as three showed a strong preference for thinness over fat, and made comments like “I hate her because she has a fat stomach” and “She’s fat and ugly.”

I have a better idea for a public health campaign, one that’s supported by research and experience. Let’s take the best ideas from campaigns like this one and frame them around health instead of weight. Instead of trying to make fat kids thin, the goal would be making all kids healthier.

We don’t fully understand why some people become obese and others don’t. But we do know that all of us, no matter how old, no matter how fat, benefit from eating well and getting exercise. We know that friends are good for our health and that bullying hurts the bully as well as the victim. We know that shame drives people like my Aunt Selma to self-destructive behaviors. In my campaign, the word obesity would never be mentioned. But the words health, respect, and compassion would be on every page.

You're invited

to the next--and probably last one for a while--Maudsley Parents conference. This one is very exciting, because it's covering not just Family-Based Treatment but a broader spectrum of issues in child and adolescent eating disorders.

The one-day conference will bring together families, clinicians, and experts to talk about the current state of treatment in child and adolescent eating disorders and new directions for the future. It's being held in an absolutely gorgeous hotel, the Pearl River Hilton, in Pearl River, NY, about an hour outside of New York City.

Featured speakers include Debra Katzman, MD, on the current state of treatment for kids and teens with eating disorders; Rebecka Peebles, MD, on the medical side of treating kids and teens; Katharine Loeb, PhD, on the need for early intervention (and how best to achieve it); Evelyn Attia, MD, on the role of medication in treating eating disorders in kids and teens; and Daniel LeGrange, PhD, on working with families from both a therapist's and parent's point of view. Oh, and I'll be talking about the parents' perspective as well.

We've worked hard to keep the price reasonable, so families who are already financially stressed can attend. If you register before 12/31, the cost is $60; after 1/1 it's $75. We've reserved a block of rooms. For more information and to register, click here.

So please join us for what promises to be an educational and entertaining day! See you there.

What do you expect from the research journal Obesity?

This is what you get, at least on the cover of the journal's November issue:



I don't know about you, but I think Santa looks kind of grim. Ill, even. Someone should tell him that physical activity and fitness are a lot more important than weight. He might want to read up on the fact that being heavier later in life isn't such a bad thing, that in fact weight loss later in life isn't a good idea. So long as he stays active, making and delivering all those gifts, he'll likely live to a ripe old age whatever his weight.

Someone should give that guy a cupcake.

Looking for . . .

Greetings everyone!

I'm working on a story for the New York Times, and am looking to interview any of the following:

--> eating disorders therapists or clinicians with a history of eating disorders themselves
--> eating disorders patients who have been treated by therapists, nutritionists, etc. who have had a history of ED themselves

I'm looking to explore the pros and cons, so any and all feedback is welcome.

Please email me at hnbrown at syr dot edu if you'd like to chat or email. And please pass along the word.

Thanks!

Another entry in the annals of Bad Ideas in Eating Disorders

is a soon-to-be-aired reality show called, I kid you not, "Starving Secrets with Tracey Gold.

The idea is that child actress-grown-up Tracey Gold, who nearly died from anorexia in her early 20s but is now married and recovered, will meet one-on-one with women suffering from eating disorders. As the show's early PR puts it, Gold will "work with women in the grips of anorexia or bulimia as she uses her own experience to reach them in ways no one else can."

Really? No one else but this particular former actress can help these women? I knew the state of treatment was bad, but not this bad.

And who the hell gave the show this title? It doesn't sound like it's designed to help. It sounds like viewers will be treated to pro-ana tips from Gold.

I'm sure that's not her intention . . . right? Someone reassure me? Because so far I'm unconvinced.

I'm not a fan of reality shows in general, especially when they purport to stage interventions or reveal long-held secrets in a very public forum designed to entertain other people. They can't help but be exploitative-that's their whole raison d'etre. But this one sounds particularly egregious.

Ugh.

Britney Spears, before and after Photoshopping

If you're reading this blog, you probably know what I'd like to say about this. But I think I'll let the image speak for itself.

Come talk to me!

Thanks to Maudsley Parents and the University of Chicago for hosting an evening with Dr. Daniel le Grange and myself at University of Chicago on October 20th. This is your chance to meet up with other families who may have dealt with eating disorders, to learn from them, and, most important, to not feel isolated or alone.

This event is free, thanks to the generous sponsorship of Maudsley Parents, but you must RSVP to reserve a place: RSVP@maudsleyparents.org.

I hope to see you there!

Upcoming events

In honor of the paperback version of Brave Girl Eating, which was just released, I'm doing some events this fall, and I'd love to see you at any of them. Here's what's coming up:

Thursday, October 6: I'll be reading at Syracuse University's Nonfiction Reading Series. This should be an informal chance to hear excerpts of the book and talk. 3:30-5 p.m., 500 Hall of Languages, on the Syracuse University campus. Free!

Thursday, October 13th: I'll be reading from the book, along with Randy Cohen, who write "The Ethicist" column for the NY Times magazine for many years; poet Charles Martin; and others. 6 p.m. At Lubin House, 11 E. 61st St., NYC. Free!

Thursday, October 20: I'll be reading from the book, and facilitating a conversation with Dr. Daniel le Grange and families who have struggled with eating disorders. This will be an informal evening, with chances to connect and talk and ask questions. Sponsored by Maudsley Parents. 7 p.m. At the University of Chicago's Quad Club, 1155 E. 57th Street, Chicago, IL. FREE, but please RSVP to RSVP@maudsleyparents.org or or call Leah Boepple at 773-702-0789.

Hope to see you in Syracuse, New York or Chicago!

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.