Monday, January 05, 2009

What do YOU do?

So I'm sitting at brunch with some neighbors--new neighbors, people I don't yet know very well but whom I like a lot--and the subjects of eating disorders and weight come up, as they inevitably seem to do. It is just after New Year's, after all, and we are sitting at brunch--a feast of a brunch, actually, with omelets and homemade waffles, a big bowl of whipped cream, berries, lox, roast potatoes, clementines. Everything is delicious and there's plenty of it.

So of course the conversation turns to dieting and New Year's resolutions, obesity and anorexia. And in the space of about 5 minutes I hear pretty much every myth about eating and weight there is:

"Children are much much fatter today than they've ever been and we have to do something about it."
"There's an explosion of diabetes among children today."
"Anorexia--that's all about control, isn't it?"
"Anorexics are doing that because they want to be thin. It's a cultural pressure kind of thing."

As I've said, these are people I like but don't know very well. But I can't just keep my mouth shut. I can't. I try to maintain a reasonable facade but within minutes I'm arguing, spouting statistics and opinions, trying to keep my voice friendly, hearing the urgency in my own words. I explain that one reason for the so-called explosion of obesity in America (among adults as well as children) is that the cutoffs for overweight and obesity changed overnight, so millions of people woke up one morning and were suddenly considered overweight or obese. That while more children are diagnosed with diabetes now than, say, 30 years ago, some of that number is certainly due to increased awareness and earlier diagnosis, which is a good thing. That the numbers don't differentiate between cases of Type 1 diabetes, which is largely genetic, and Type 2, which is linked to diet and activity.

I tell them about Health At Every Size, and try to conjure as many of Deb Burgard's talking points on size acceptance as I can remember. I tell them that Tom Cruise has been considered obese according to the BMI charts.

I tell them that no, anorexia is not about control, that it's not "about" anything except having the shitty luck to be genetically vulnerable. I tell them that for a person with anorexia, eating is like--oh, I don't know, maybe jumping out of a plane without a parachute. Covered in writing snakes. Giving a lecture on the way down. That for some people, restricting (aka dieting) sends them straight down the rabbit hole, that anorexia distorts thoughts and perceptions and feelings, that it's not a question of just picking up a fork and eating.

One of my new neighbors is in medical school. She's particularly interested in these subjects because she will have to adopt a professional attitude about them sometime soon. She'll have to figure out what she thinks and how to talk to people on all parts of the weight and eating spectrum--her patients. She listens. Everybody listens. We actually have a lively and interesting conversation. I think.

But I lay awake last night replaying it in my mind, wondering if I should have taken a different approach to the discussion. It's not so much that I think I was obnoxious (though maybe I was, a little) as it is the fact that I find these conversations exquisitely painful. Every time I hear the words It's all about control, isn't it? it's like some synapse in my brain starts overheating. How do I offer my knowledge and opinions without being obnoxious or driving myself beserk?

What do YOU do when the conversation turns to subjects like this?


chartreuse said...

"That the numbers don't differentiate between cases of Type 1 diabetes, which is largely genetic, and Type 2, which is linked to diet and activity."

The statement above is misleading: Type 2 Diabetes has a far stronger genetic link than Type 1 Diabetes. Although it's true that diet and activity affect the control of Type 2, it's still almost entirely a genetic disease, which is why family history of Type 2 diabetes is so important.

Harriet said...

I'm happy to stand corrected.

Apple Berry said...

well no it's not ALL about control, but in a body image group I attended a couple years ago the two worst cases in the room (i.e. severly underweight to the point of skeletal- 'thinspo' doesn't touch how skinny they were kind of thing) both said they liked the control. Not that it was all about control, but that that was the reason holding them back from changing and aiming for recovery. Therefore, I think it is related to it, perhaps in a disconnected way it's about control. Although, it's not the only factor playing a part.

In this situation I shut up. I sometimes snap when someone makes degrading remarks, esp. when it's about bulimia and I correct them when they're hideously wrong. I also comment that everyone knows someone affected, and it's not uncommon so if I ever get found out by my new friends in particular it's so 'abnormal' so's to speak.


Anonymous said...

Oh gosh, don't even get me started on "eating disorders are all about control." While I hate the false belief that eating disorders are about being thin (that has to be the most ignorant perspective), what really irks me about the control thing is that professionals in the mental health field endorse that belief.

I think that your explanation was very organized and well through-out... much more coherent than my angry rant would have been :-)

Anonymous said...

Hi Harriet!
Great post, I can identify with your struggle, and I'll tell you why--I've successfully lost alot of weight via living a low-carbohydrate life, and I've (for the most part, give or take holiday fluctuations) been able to keep the nearly 100 pounds I've lost off during those years.
My experience is personal, you see? Sure, I can spout studies and quotes from say, a well-written book like Gary Taubes' Good Calories, Bad Calories, but I've come to terms with the fact that people are going to have their own opinions, and they're going to believe whatever information they've heard and whatever makes sense to them--there's really no getting around this, despite the best of intentions, tone of voice, or force of word--I've had friends and family raise their voice at me, predicting, "this diet is going to kill you, you're clogging your arteries, it's a fad," etc.

My point is this, Harriet; you have a very personal connection to the subject of anorexia--you're well versed in the diagnosis, causes, etc. You said what you felt you had to, and you said it with conviction--nothing wrong with that. Hopefully someone who was listening heard you.
I don't know the extent of the friendships at this gathering, but despite the fact that everyone has their own opinion about everything and anything, I do feel that a 'better human,' knowing your experience, would have kept any erroneous comments to themselves.
Just my take on it.

Anonymous said...

I would have done the same obnoxious thing. Because I'm a statistician I probably would have brought up the whole changing definitions of BMI thing, and how BMI doesn't really work for growing kids because their heighst and weight change so fast, and also the stuff about more diagnoses of diabetes. (Which incidentally applies to autism as well.)

And just when everyone was completely sick of me going on about it I would have said something snarky about not believing everything you read in the media.

People who know me well know to expect these outbursts on various topics, people who don't know me well, learn.

I don't know how comforting it is to know that I would have done the same thing, but I would have.

mary said...

I hope you don't over think yourself Harriet, not on this one. You've been educated at the school of hard knocks and experience. Right now we are still living in a world that thinks anorexia is an adjective. Most people have heard which celebrities have had it but rarely here mention of it being a very real disease that takes over. (very good description, BTW Harriet) We should be outraged! Sadly, even some parents believe it's about control as that's what their children have been told by professionals who, "in the name of help", have told them by leading them with questions and suggestion. And these are the people who KNOW that this is a disease. Or do they? A mental disorder such as this is never so simple, is it? There are likely some very different beginnings with this disease, some quite innocent, but once it gets a hold it does not let go.
We are living in a world where diets are spoken of on the daily news, almost as if it's a weather report. We are bombarded with the bad news. What's your true age? Before or after helping a sick family member? Do you own a pet?

If we don't speak up when we feel the need to we leave the myths to sit and become believed. We need to listen as well.

Alice said...

I'm rereading the list of things that you heard at your brunch, and a couple things stand out. There are a couple routes you could take with this thing: steer the conversation towards a discussion of body image and maybe get them thinking that fat--when it isn't a health risk--isn't bad. Then you are not arguing statistics and trying to prove who *knows* more than the other person.

I have to say something about the anorexia/control thing, too. It's really hard for me to believe that all anorexics are motivated by the same thing, and such statements like "it's a cultural pressure kind of thing" seem grossly oversimplified. However, in many cases, self-destructive behavior IS about control. By all means, offer your friends some alternative analyses of anorexia, but do so in a way that reminds them of the complexity of the situation. Remind them that not all anorexics are the same, just like not all diabetics, chubby kids, and fat adults are the same.

So what I'm trying to say is, yeah, I probably would have done the same thing in your situation (including the agonizing over it at night) and I think these are the conclusions I would have come up with.

Anonymous said...

Oh the craziness of these assumptions! I'm not as medically educated but I'm versed enough to recognize the false assumptions, and they are *frustrating.* I hate to admit it, but sometimes I let it slide, change the subject...sometimes I give them the URL for the JunkFood Science blog. It depends on the situation and the person; in days we don't trust the media about anything else, I don't fully understand why people buy wholesale what is being said about health and body issues.

Katie said...

I also hate situations like this but I am glad to hear that you voiced your opinion. As said by others, you know the facts, you know what you're talking about. It is time to educate others becasue there are too many misconceptions regarding eating disorders and weight issues.

familyfeedingdynamics said...

As a former physician, now devoting my career-life to teaching parents how to feed their kids, PLEASE don't give up on the medical student neighbor. Doctors mean well, but I honestly was simply not exposed to a huge portion of the "evidence" when it comes to weight and feeding issues. I am a Satterite when it comes to feeding, convinced that if we help families feed themselves from infancy on, we can prevent so much misery. Health at Every Size model fits in nicely. The media and the medical community are throwing fuel on the fire, and feeding our dueling epidemics of eating disorders and sedentary obesity rates.

Harriet said...

I love that you're working with parents on feeding. That's awesome. I too am a Satterite (kind of like a satellite?). I know that what you're saying about docs not being exposed to this stuff is true. I've given talks on eating disorders to roomfuls of pediatricians and watched half of them scribbling madly because they were soaking up the information and the other half sit back, arms crossed, and tell me I was nuts to come out against dieting for kids. There is so much misinformation out there, and of course doctors are just people and aren't immune to it. And med schools do a crap job (or no job at all) in teaching docs what they need to know.

I think my neighbor is very intelligent and wants to learn. I give her high marks for that and look forward to seeing where she takes it.

Ari J. Brattkus said...

What do you think of Sanjay Gupta being appointed as Surgeon General? He is such a "OMG obesity among children is running wild" type that I worry that the emphasis will be on misinformation and scare tactics rather then real information...

Harriet said...

I'm with you on Gupta--anxious about what he will say/do.

It's also my only reservation about Obama. . . .

Anonymous said...

Hi, Harriet--

I thought you handled the whole thing quite well. Of course you should correct misconceptions and lack of understanding---you were the only one there with real knowledge and experience. You were the only authority. I just hope you (and others who commented) will forgive the ignorance of people who honestly don't know and have little opportunity to learn, except from snippets in the media which, as you point out, are often very misleading even when they come from the medical community. You can't blame people for believing obesity is increasing when that's what they have shoved down your throat at every turn.

I, for one, learned a lot at that brunch. I think everyone there took what you said very seriously and their opinions were changed for the long term. You weren't obnoxious at all...I just hope you don't think we were!

Harriet said...

God no, Shander. You guys were amazing. What I'm really feeling, I think, is my own anxiety whenever the subject comes up.

I met with the woman who started Ophelia's Place today. We were talking about how many misperceptions there are around here of eating disorders, even (especially) among professionals. I think everyone at the brunch table was more open than many docs around here. Alas.

Anonymous said...

It's always anziety-provoking to set people straight in public. I totally empathize. (Remind me sometime to tell you about the neo-Nazi incident in Las Cruces, NM.)

Anonymous said...

Hi Harriet,
Yes, I think we all can empathize with feeling anxious about how to navigate a conversation that we have a lot of investment in and that we are self-taught authorities about! It sounds like you aced it. :)

I do wonder, though.. I've been reading your blog on and off for about 8 months now. Do you ever recognize that there is an obesity problem in the States? Though I am on board with the message that 'fat' does not equal 'unhealthy,' and I am certainly opposed to pathologizing a group of people who have nothing wrong with them, I still believe there is an obesity-related health problem in this country.

In public, I feel I need to be an advocate for fat acceptance (or maybe, Health at Every Size), but I also want to find a way to acknowledge and distinguish the obesity-related health problem that does exist. I'd love to hear your thoughts about how to address this with an even hand. Or, if you've already written on this, could you drop the link?