Wednesday, April 18, 2007

There is no way to prevent anorexia

As I wrote the title of this post, I felt a wave of despair. Until a couple of days ago, I had never put this thought into words, never articulated it to myself. But it's true.

Two years ago I would have said of course you can prevent anorexia. I certainly never believed my daughter would develop it.

She was smart. She was funny. She was self-aware. She was eminently rational, and had been since toddlerhood. She watched no commercial TV. Her videos were carefully screened. She was a feminist before she started kindergarten.

Every kid in her sixth-grade class had to do a research paper on a subject of interest. She did hers on eating disorders. Looking back, I understand that that right there was a clue. At the time, I thought it made her safer because she had knowledge, she understood, and she was warned.

I thought that years of modeling a healthy attitude toward my own body would protect her. (I was fooling myself there, too, but I tried hard.)

But here's the thing: Nothing that she did or I did protected her from anorexia. Because there is no way to prevent an eating disorder.

If anorexia could be prevented, we wouldn't need to be talking about treatment. We wouldn't need to watch children suffer or families unravel.

I know from my own daughter's experience that knowledge does not prevent anorexia. She knew more about anorexia in sixth grade than many doctors do. She understood the dangers. More, she knew she was--as a gymnast and perfectionist--at risk. But it didn't help.

I'm all for the studies now being done on treatments for anorexia. They're long overdue. But where are the studies on prevention? Why is no one even asking the question of how to prevent anorexia and bulimia? Cynthia Bulik has looked at anorexia and twins--this would seem to be a perfect area of research for her.

We know that genetic predisposition plays a huge role in eating disorders. We know that environment can be a catalyst. How does the famous saying go? Genes load the gun and environment pulls the trigger. What we don't know is how to put the safety back on the gun. We'll never know until we start the scientific process of figuring it out: coming up with hypotheses, testing them, recording the results, making connections.

I've watched half a dozen young women I know--all of them bright, funny, well-read, engaging--fall prey to anorexia. I can look around at the young teenagers I know and predict, now, who's at risk. It's like watching a train wreck in slow motion.

Treatment is crucial. God knows we need better treatments for anorexia. Maudsley treatment is the best we've got so far, and it saved my daughter's life. I'm grateful. But it's not enough. Enough is when we can keep kids from becoming anorexic in the first place.

I don't have the answers. Maybe it's a combination of things: a vaccine, education, behavior modification in those at risk. I don't know. But I do know that until we start asking the question, we'll never find an answer.

Monday, April 16, 2007

Clinton's crusade

Bill Clinton's new crusade against obesity is making headlines and blogs around the world. The media just can't resist the image of a formerly fat former president calling for more ammo in the war against obesity.

If only Clinton would harness his power for good--imagine what he could accomplish!

Don't get me wrong--I'm an FOB (fan of Bill's) from way back. But I sure wish he'd take a stand for something truly meaningful, like national health insurance or truly meaningful mental health parity. Or how about pushing for an hour-long school lunch, like the French have? Or daily recess for all schoolkids?

And hey, Bill, as you wield your influence for the good of children everywhere, I hope you will take the time to educate yourself about eating disorders. I hope your efforts stay focused on supporting children's health in all ways rather than fat-bashing--which we all know is ineffective at best and cruelly destructive at worst. I would hate to see more of what helped trigger my daughter into food restricting and, ultimately, anorexia: mindless labeling of "good" foods and "bad" foods, fear-mongering at the table, and more prejudice against those who don't conform to cultural ideals.