Saturday, January 19, 2008

How you eat is also how you live

Dietitian and therapist Ellyn Satter has been writing about food and eating for years. I often think of her words when I think about my own or others' eating troubles. According to Satter, the goal for all of us is to have "a joyful, competent relationship with food." Years of research have helped her define what it means, exactly, to be a healthy, competent eater:

Competent eaters have positive attitudes about eating and therefore are relaxed about it. They enjoy food and eating and they are comfortable with their enjoyment. They feel it is okay to eat food they like in amounts they find satisfying.

These three little sentences are about as radical as the Declaration of Independence was 225+ years ago. Consider all the ways in which our culture doesn't encourage us--especially women--to enjoy food, to feel it's OK to eat food we like in amounts we find satisfying. So many of us are terrified of food and of our own appetites; this little manifesto puts the power squarely where it belongs and where it always has been: with us.

Satter's latest newsletter takes her research a step further, in a direction I find very interesting indeed:

Competent eaters do better with feeding themselves and have positive health indicators. None of that surprised me. What did surprise me, although it shouldn’t have, is that competent eaters are emotionally and socially healthier than people with low levels of eating competence. They feel more effective, they are more self-aware, and they are more trusting and comfortable with themselves and with other people.

That's right, folks: Being competent with eating correlates with emotional and social health. Not dieting. Not weight loss. Not binge eating. But maintaining that joyful, competent relationship with food and eating.

Satter goes on to explain the connection:

Consider that being emotionally and socially healthy--emotionally competent, if you will--depends on being sensitive to and comfortable with what goes on inside you--knowing what you feel, what you want, who you are--and being honest with yourself and with others about it. Your comfort and honesty with yourself allow you to act on your feelings in a rational and productive way. You can appreciate not only your own feelings and wishes but those of other people and, as a consequence, be reasonably adept at working things out. Being competent with eating depends on exactly the same processes: being sensitive to and comfortable with what goes on inside you and being honest with yourself and others about it.

Amen, sister.

Thursday, January 17, 2008

Hitting a nerve

Back in October I posted about some of the marketing brochures I collected at the NEDA conference. I singled out one from Rogers Memorial Hospital, partly because it was so egregious and partly because Rogers is the closest residential treatment center to my town, and it's the place my daughter likely would have gone had we chosen in-patient treatment for her.

I've been meaning to post the follow-up to that thread, which was that I got a letter from the COO of Rogers Memorial himself. Here for your edification are some quotes from the letter, along with my commentary.

Quote: Your comments and suggestions for improving our brochure have already been received by our marketing department and will weigh in our minds when we revise our eating disorder materials in the future.

Commentary: The point wasn't a critique of the brochure; I was discussing the program. Big difference. Revising the marketing materials isn't going to change your outcomes for the real live people who go to Rogers. Point well and truly missed.

Quote: We would appreciate the consideration of sending us such criticism directly, rather than taking your complaints immediately and directly to a public forum like your website.

Commentary: I'm sure you would. And I'm sure, had I called you with my "complaints," you would have taken them very seriously indeed.

Quote: Advocates for mental health must work together to achieve greater awareness and to break down the stigma that our society attaches to mental health disorders.

Commentary: I'm with you on that one . . . though I think my notion of advocacy is probably not the same as yours. To me, advocacy means empowering patients and their families with accurate and true information, true choices, and effective treatments.

Quote: Schedule a visit to our campus and really get to know our medical staff and administrators who have trained and practice Maudsley approaches and techniques when they are applicable.

Commentary: It's those last four little words that give it away: when they are applicable. Family-based treatment is the standard of care for adolescents. It should be the norm rather than the exception.

I know there are caring staff at Rogers Memorial. I challenge them to take a hard look at their treatment protocols for teens and evaluate them in the light of evidence-based research--then come up with a new vision. You have the potential to do a lot of good. I'd love to see you doing it.

Wednesday, January 16, 2008

Civil rights

I just wrote this in a comment on another post, and thought it was worth repeating in a post all its own.

We need a civil rights movement for fat people.

Fat acceptance is great, but we need to go a step further. We need our own Rosa Parks and Martin Luther King, Jr. and Mahatma Gandhi. We need civil disobedience. We need to picket outside the offices of for-profit bariatric surgery clinics. We need to Act Up, not shut up.

We need to teach our own culture an essential lesson once more: That each and every person is a valuable human being, regardless of the color of his/her skin, intelligence, country of origin, gender, sexual attractiveness, or weight. Hell, we need our own song.

We're talking basic civil rights here. Who's on the bus?

Tuesday, January 15, 2008

Part 2: Obesity and insurance

Part 2 of my local paper's coverage of bariatric surgery starts like this:

If you smoked a pack of cigarettes every day for 20 years, you might develop lung cancer. Most insurers would pay for surgery and other cancer treatments without quibbling over it.

But if you gradually piled on weight, then developed diabetes or other problems from obesity, your health plan likely would not cover weight-loss surgery without a fight.

Shocking, isn't it? A medical condition insurance companies don't cover. (I'm putting aside for the moment the underlying assumptions here: obesity = medical condition/disease, obesity --> diabetes and other diseases, obesity is volitional.) How could this be, you wonder?

Alas, I don't have to wonder. Two years ago I fought with our insurance company--and lost--over its coverage of my daughter's treatments for anorexia. Because anorexia is considered a mental illness, and because our progressive-in-reputation-only state does not have mental health parity, our insurer got away with covering only a small percentage of the cost of my daughter's treatment.

Where were the incredulous newspaper stories then? Where was the hue and cry, the uproar at the injustice?

Uh-huh. I thought so.

Monday, January 14, 2008

Of surgery and blame

There's nothing new about bariatric surgery, even in the midwestern outpost I live in (once a New Yorker, always a New Yorker!), but this front-page story in this morning's paper made me see just how mainstream it's becoming--so mainstream that health insurers here are beginning to cover it.

The good news is that the story focuses on the risks of weight-loss surgery: internal bleeding, bowel obstructions, leaks in the new pipeline, blood clots, and cardiac complications. The local hospitals that do the procedures have complication rates about the national average--between 8 and 11 percent. (I wonder how this compares with complications rates of other kinds of surgery; anyone out there know?)

What made me sick was not just the literal description of the surgery, though that was graphic and disturbing. It was the curiously familiar rhetoric that accompanied the story's generally positive view of these procedures:

". . . some doctors [say] patients are looking at the surgery as an easy solution.

'I see a lot of people who are in a miserable situation, and they 're looking for a solution, and surgery seems like an easy solution,' said Dr. Edward Livingston, a bariatric surgeon at the University of Texas Southwestern Medical School in Dallas.

'But this is a big life change. It requires a great deal of investment on the patient 's part to make it work.'"

Sound familiar? It should. Like so many other diet pills and weight-loss plans, it comes with a heaping helping of guilt and blame: You say people are miserable and are just looking for an easy solution? How dare they! They should be made to suffer.

And suffer they will, if they have bariatric surgery. If they're lucky, like the woman profiled at the top of this story, they will get to go off their meds for diabetes, sleep apnea, etc. Assuming, of course, they were on them in the first place. If they're lucky, they won't die as a result of the surgery or have complications that cause them long-term pain and disability.

And even if they are lucky, they're still likely to face buyer's remorse. "This is a lifelong commitment, and there are going to be days when you're sorry you've made this commitment," says the woman profiled in the story.

I bet. I find the word commitment to be an odd one here. What we're really talking about is a procedure that mutilates the human body, with long-term consequences like absorbing 77 percent fewer nutrients from food--for the rest of your life. That's not a commitment; it's something you endure.

But the underlying assumption, here as elsewhere, is that there's an element of choice about being obese. And that's what I find frustrating and upsetting, that our culture assumes that whenever you deviate from the cultural norms around weight, it's your fault. Whether you're obese or anorexic, you are to blame, and you are to be punished.

If I were a therapist, I'd have to ask: How does this help us? What's the secondary gain of seeing weight as a reflection of intention, behavior, and responsibility?

These are the kinds of questions that stories like this one should be asking.