Are you going to NEDA?

To the annual National Eating Disorders Association conference in San Diego, that is. If so, please look me up and say hello. I'll be presenting on Friday afternoon, along with Dr. Walter Kaye and Laura Collins, author of Eating With Your Anorexic. Stellar company and what promises to be a much-needed panel discussion on families and eating disorders treatment.

Finally, we're talking about eating (rather than weight)

Amid the usual hysterical news stories about the so-called obesity epidemic I was pleased to come across an item about new research out of Penn State looking at eating competence as a risk factor in heart disease.

Using an eating competence scale developed by Ellyn Satter, researchers found that--surprise, surprise--people at risk for heart disease fared better when they were "confident, comfortable, and flexible with their eating habits."

Being comfortable with your eating seems to mitigate other risk factors, including elevated LDL cholesterol. It's process over product, holistic health over health-by-the-numbers. It's the act of eating rather than the rigidly controlled carbs and calories approach.

Now we know the truth: fear of food is bad for your health. Mangia va bene!

Eating Disorders Coalition action alert

Anyone who's ever tried to get a mental health issue covered by insurance (or, as they're called in our state, "behavioral health issues") will want to act on the EDC's latest action alert:

"You can help Pass the Paul Wellstone Mental Health and Addiction Equity Act (H.R. 1424) today by calling House Speaker Nancy Pelosi toll-free at 877.978.9996 and telling her that you support the passage of this mental health parity act."

The sound of one shoe dropping

The other shoe, that is. It's been a hell of a few years in our household, between medical traumas of various kinds, including Kitty's anorexia, my mother-in-law's lingering illness and death, and now the legal machinations of her despicable and greedy second husband. (Who knew people could be such asshats?)

So now I'm down with some health problems of my own, hopefully not for too long and nothing permanent, but very unpleasant in the short term.

So forgive me if I don't do too much posting for a little while. Carry on.

Today's post is a poem

It's true: I cop to being a poet first and foremost.

SEPTEMBER 11, 2001: POEM FOR MY LATE FORTIES

See, one day I realized I was thinking about death
as if it were a problem I could solve, as if
through sheer brilliance, hard work, or luck
I could outwit my fate, land safe on solid ground.
So all of this, I mused—-the sweet blue sky,
the falling light, the dizzy bone-deep fix
of oxygen and sun and fire—-was plain
out of my hands. I was free, it seemed,

to keep on stumbling—-blind, confused,
ticked off—-up the old twisting path,
to reach the top at last and claim
my prize: to face the dark wood,
as the poet said, and, pissing
in my pants with fear, go on.

To be published in Oberon later this year

Entering the dieting/FA fray

I'm going to tell you a story: I once had a friend named Mimi Orner who was a fat activist, woman of size, brilliant teacher, and all-around wonderful person. Here in Madison, Wis., where I live, she started a group that was anti-anorexia, anti-bulimia, and anti-dieting. This was about 15 years ago, mind, somewhat ahead of her time.

Mimi died seven years ago from ovarian cancer. Her appetite for food, like her appetite for life, lasted until pretty close to the very end. Her memorial service was attended by hundreds of people, many of whom got up to speak. All of these tributes were very moving, but the one I remember was a young woman who stood up, tears pouring down her face, and confessed that she and Mimi had once been close but of late had been a little bit estranged. "I found her so inspiring," she said through tears, "and I want to believe what she ways [about fat acceptance]. I'm not as smart or as good as Mimi. I just can't accept myself as a fat person, at least not yet. So we grew apart. And I've missed her so much. And now I'll never have the chance to make it right."

This young woman's words have stayed with me because they capture so vividly the dilemma of the individual and the political. Sometimes, you know, the emotions take a while to catch up with the intellect. Sometimes they never do. That's part of being human. We can't legislate our feelings.

Much as we might like to sometimes.

I miss Mimi too. I wished she was there two years ago when my daughter got sick. I wished she was there when I gained 50 pounds from a medication and struggled with that. I wish she were here now, so we could debate and argue and disagree and learn from each other.

Ass-backward science

I used to think the Brits were far more evolved than we Yanks. But that was before Marcella sent me this unbelievable bit of rationalizing from the U.K Food Standards Agency.

According to guidelines passed by the FSA, cheese, honey, marmite (that's how you know you're in the UK), and breast milk* are unhealthy and therefore banned as the subjects of food advertising to kids.

On the other hand, chicken nuggets, microwaveable curries, oven chips (I assume this is french fries), and diet sodas are A-OK, according to these standards.

This is what I think of as ass-backward science: First you decide what result you want your data to show. Then you screw with said data until it shows it.

So the makers of chicken nuggets can happily continue to flog their stuff to the kiddies**, but the beekeepers and cheese makers are SOL.

Nice going, guys.



* Breast milk's fat content would render it unhealthy by the FSA's standards.

** I lived in London for a year and I speak Brit too!

A basic misunderstanding of anorexia

has got to be part of where nutrition "expert" Dr. Elliott Berry is coming from when he offered the latest in potential anorexia treatment: cannabis.

You can't blame Dr. Berry; anyone who reads DSM-IV gets the same wrong-headed criteria for anorexia front and center: Anorexia is a "refusal t maintain body weight at or above a minimally normal weight for age and height."

It's the word refusal that is so misleading. Those of us with personal knowledge understand that it should read inability to maintain body weight. Someone with anorexia isn't "refusing" to eat, because s/he's not really capable of making a choice on the subject of food and eating.

I'd love to see this definition change, and with it our notions of good treatment. I'd love to see a time when starvation would not be an option, when we didn't confuse appetite with illness. And I don't think cannabis has any place in the treatment of anorexia.

What obesity is

At least according to endocrinologist Robert Lustig: “Obesity is not a disease or a behavior. It’s a phenotype (a trait or characteristic in a subset of the population), which is a manifestation of many things.”

Lustig was talking about why there will never be a "one-size-fits-all" weight-loss drug.

Now if only he'd gone a step further, and questioned the need for a pill to change a phenotype.

Why intuitive eating works

This just in from an article published in today's edition of the Journal of Physiology: ". . . during a reduction in energy stores or circulating nutrients, the brain initiates responses to restore and maintain energy and glucose homeostasis. In contrast, in times of nutrient abundance and excess energy storage, the brain promotes reduced food intake and increased energy expenditure."

In other words, deprivation makes your brain and body store fat. But having access to plenty of food can lead to eating less and moving around more.

This has always been my experience. When I give myself permission to eat what I'm truly hungry for--and stop eating when I'm satisfied--I eat less than when I go into deprivation mode.

It's interesting to know that there's neurobiology at work. The human body is a wonderful thing.

F as in Fat, K as in Knee-Jerk

On our last morning in Utah I picked up a copy of the Salt Lake City Tribne and was appalled (but not shocked, alas) to read an editorial based on the Robert Wood Johnson Foundation report mentioned a few days ago. Its concluding paragraph:

If you're "F" as in fat, you'll be "D" as in dead.


Talk about scare tactics. . . .

I haven't done a search, but I wonder how many other newspapers picked this up and ran with it.

The good doctor

After reading fillyjonk's recent post over at Shapely Prose, and all the comments that followed, I realized it's time to say thanks to my wonderful internist.

So here's to you, Dr. Nancy Fuller, for being the kind of doctor who has never slapped the scarlet O on me. To you I am a patient, not an unacceptable number on the scale. I've brought all kinds of health issues to your office, from panic disorder to hot flashes to headaches, and never once have you said or implied that it's All Because I Need to Lose Some Weight.

Thank goodness you are not Dr. Sanjay Gupta, who writes in Time magazine, "Obesity, of course, means a higher risk of heart disease, diabetes, hospitalization and early death, so how come doctors are so lax about putting the scarlet O on the chart?"

How come indeed, Dr. Gupta?

Could it be that some doctors look beyond the numbers on the scale to a patient's true health? That they know all too well that putting a patient on a a diet through scare tactics will almost always backfire, winding up with the patient heavier than they already are? That shame is not a good motivator, and neither is fear?

Could it be that some doctors are not as egotistical as you, who seem to to believe that those who are fat don't really know it until it's pointed out by a doctor?

Could it be that some doctors have gone a little deeper into the subject, and know that fat does not always (or even usually) equal bad health? That fat can be fit and healthy, and thin can be unhealthy?

I far prefer my good doctor's approach. She takes time to talk with me, listen to me, guide me toward healthy choices in all ways. When I walk in the door she sees me, not just my measurements. And so I trust her.

And that's the basis of a healthy doctor-patient relationship.

Another missed opportunity

The Robert Wood Johnson Foundation has just come out with a report, "F as in Fat: How Obesity Policies Are Failing in America in 2007," in which it makes the same tired (and superficial) observations and beats the same dead horse some more. According to the report:

* Adult obesity rates rose in 31 states last year.
* Twenty-two states experienced an increase for the second year in a row; no states decreased.
* A new public opinion survey featured in the report finds 85 percent of Americans believe that obesity is an epidemic.

This last one made me laugh out loud. And this proves what, exactly? That most Americans will believe anything the media spoon-feeds them? Deep into George W. Bush's second term, we already knew that. But I digress.

* Rates of adult obesity now exceed 25 percent in 19 states, an increase from 14 states last year and 9 in 2005. In 1991, none of the states exceeded 20 percent.

Of course the report fails to mention the change in the BMI chart that created millions of new overweight and obese people overnight. Oops--I digress again.

* "There has been a breakthrough in terms of drawing attention to the obesity epidemic. Now, we need a breakthrough in terms of policies and results," said Jeff Levi, Ph.D., executive director of Trust for America's Health.

You got that right! You'd think that maybe this would be the moment to stop, take stock, and say, Wait a minute, maybe we're fucking up here. Could it be that we're actually making things worse by flailing around? But no. Levi went on to say, "Poor nutrition and physical inactivity are robbing America of our health and productivity."

Give me a break. He's just parroting the conventional lack of wisdom that says all fat people are couch potatoes eating junk food and watching TV.

The press release goes on to tout other "key findings":

* Twenty-two percent of American adults report that they do not engage in any physical activity.

But there's no context for this. Has this changed? I think people are more physically active now than they were 20 or 30 years ago. When my grandmother and mother were my age, they weren't out hiking the Utah mountains or dancing all night. They didn't go to the gym, jog, or play softball. And yet we're the ones who have the "obesity epidemic."

Once more, an opportunity for reflection and going beyond the conventional wisdom--sadly missed.

But the report does more than list problems. It proposed solutions. Solutions like this one, which tops the list:
* The federal government should develop and implement a National Strategy to Combat Obesity. This plan should involve every federal government agency, define clear roles and responsibilities for states and localities, and engage private industry and community groups.

I don't know whether to fall on the floor laughing or be truly frightened. And what about this:

* Federal, state, and local governments should work with private employers and insurers to ensure that every working American has access to a workplace wellness program.

I don't want a workplace wellness program, because what I know about them is that they're as much a joke as school wellness curricula. They exist to penalize workers who don't measure up to the approved guidelines, through surtaxes for those who are overweight, for instance. Unless they're paying for health club memberships for employees, and giving them an hour and a half lunch to go work out, I don't want to hear about it.

If RWJF has its way, our already eating-disordered culture would go beserk. Talk about obsession--they want to get the whole freaking government involved.

What a nightmare.

**Read the press release yourself at www.rwjf.org/newsroom/newsreleasesdetail.jsp?id=10512, which also has a link to the full tet of the report. Sorry I can't link it--still remote blogging.

Fat as metaphor

Meowser's comment on an earlier post got me thinking. She wrote:
"Whenever I see/hear anyone complaining about fat people walking around, or at the gym (where we're just piddling around and slowing things down for the buff crowd, you see, no fat person could possibly be getting an actual workout there), or dancing, or riding around on bikes, it totally gives the lie to the "unhealthy! unhealthy! diabetes! diabetes!" meme. Because people like that would totally rather we stay home and stuff our fat faces where they can't see us, rather than actually move around. I believe my mother cares about my health. I don't think some random stranger who doesn't know me really gives a damn if I'm "healthy" or not, and in fact, it would really piss them off no end if I had numbers proving that, apart from my weight, there is nothing wrong with me.'

I've been thinking as fat-as-a-symbol, the way it's most often used: as a metaphor for imperialism, greed, overconsumption, etc. Meowser's comment makes me wonder if it's also used as a symbol for questioning authority. Do fat people stick in the craw of the entitled thin establishment because we're not following the rules? Because we aren't doing whatever it takes to get thin, and stay thin? Do we piss them off because we're perceived as thumbing our noses at the authority figures?

I find it interesting that in a time of such extreme individualism, this is one area where being quirky, or not fitting the mold, is perceived as being unacceptable. We've become such a tolerant society in so many other ways. Though I know we have a long way to go on racism, still we've come a long way. When I was in college I was at the center of a near race riot, caused in part by my dating a black man and by the reactions of both whites and blacks on campus. That wouldn't happen today, not even in the deep south. The kind of anti-Semitism I bumped into as a child wouldn't be tolerated today, either.

So what is it about fat that gets people so riled up? Maybe fat people challenge, by our very existence, the marketing economy we can't escape. We're not buying into the pills, creams, products, etc. that are supposed to make us thin. (Though God knows many of us *have* bought those things, in the millions.) Maybe it's that fat people are perceived as not buying into the marketing imperatives about aesthetics, which are used to sell everything to everyone, from cars to cereal. We're not good consumers in the broadest sense of the word.

I wonder.

And what's the point, anyway?

This whole you-can't-be-fat-and-fit, fat-is-always-unhealthy thing is really bugging me. Because really, what's the point?

The debate is beginning to remind me of my second-grade friend Linda Read, who had just learned in catechism that people like me--i.e., Jews--were going to burn in hell forever. And because she was my friend, she tried to convert me, of course, to spare me the suffering she knew was coming my way someday and forever.

Now let's say that guys like Walter Willett and Paul Raeburn (see previous post) are like my friend Linda. They really really believe that people like me--i.e., fat people--are going to health hell. Either we're going to get terrible diseases or we're just going to keel over at a tender age. (I once listened in astonishment to a neighbor talking about a certain fat actress on TV: "I can't even stand to watch her because I just know she's going to drop dead at any second!") So they set out to convert us.

But they know that it's not that simple. They know, for instance, that for most people dieting does not work, for a variety of reasons. Now here's where I really don't get it. Because you'd think the next tactic would be to encourage positive behaviors like fitness. Some fat people will lose weight that way; some won't. But we do know that being fit is a good thing no matter what your weight.

So why, then, do we get drivel like Raeburn's piece in Scientific American on how you can't be fat and fit?

Is the point to to shame us out of getting out there on our bikes and exercising? (I thought the photo at the front of that piece was exploitative.) Is the point to make us throw up our hands and say, "Well, no reason to bother exercising, since the only thing that counts is losing weight."

It feels so disingenuous. It feels like the point, such as it is, is fat bashing. So what if you're a triathlete--if you weigh 300 pounds then you can't possibly be healthy, so don't even bother.

And this bothers me far more than the other kind of health crusaders, the ones who are really like my friend Linda Read. Who worry for our fat souls, as it were, and want to save us.

These guys just want us to go to health hell already. And that makes me mad.

Because he said so, dammit

This article by Paul Raeburn in the September issue of Scientific American, starts out well but quickly goes belly-up. So to speak. Raeburn's burning question--"Can fat be fit?"--is presented as genuine, but it's clear from the second graf that he's got an agenda rather than a genuine curiosity about the question.

He pays lip service to Katherine Flegal's research showing that being overweight (BMI between 25 and 30) may actually lower your risk of mortality. Flegal's drawn a lotta flak since her study came out, of course, and no doubt there's more to understand. But Raeburn doesn't try too hard. He sets Flegal up as a straw man and knocks her down fast with other research that seems less than compelling. He quotes Walter Willett of the Harvard School of Public Health, and writes, "Willett’s research has identified profound advantages to keeping weight down—even below the so-called healthy levels."

Here we have it once more, ladies and gentlemen, the mantra of so much that's being written these days about fat and thin. Flegal's research doesn't count because, as we all know, the lower your weight the better.

I can hear Willett saying, "Fat is too bad for you! [foot stomp] Why? Because I said so!"

I don't know Paul Raeburn's writing, but I do expect better than this paltry effort from Scientific American.

Sandy Szwarc is my hero

If you'd like to know why, see her blog post today on disease vectors at http://junkfoodscience.blogspot.com/2007/08/disease-vectors.html.

Finally, someone with some common sense about fat

And that would be a research team from Penn State University, warning that parents should not deprive their children of fat, despite all the hysteria about obesity.

"The authors said, 'Sufficient fat must be included in the diet for children to support normal growth and development.'

The authors said dietary fat recommendations are higher for children aged four to 18 (25 to 35% of energy) compared with adults (20 to 35% of energy)."

Gee, I could have told you that.

Interestingly, the only news articles I could find on this were published across the pond, in the UK. Hmm. Could there be a reason why this isn't being plastered across CNN?

Read all about it yourself at http://www.inthenews.co.uk/thebigissue/news/health/psu-researcher-sufficient-fat-needed-$1123529$1123528.htm. (Sorry, this remote blogging thing doesn't let me post links. Bummer. Anyone out there know how to fix it?)

Interesting new report on anorexia

In the August 7 issue of the International Journal of Eating Disorders, researchers at Rouen University Hospital in France describe a woman with anorexia who was found to have a brain lesion. When the lesion was treated, the anorexia went away, supporting the notion that AN is indeed a disorder with strong roots in the physical brain.

I'm blogging remotely today, so I can't post a direct link, but you can see the study abstract at http://www.ncbi.nlm.nih.gov/sites/entrez?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=17683096&itool=pubmed_DocSum.

Not for the humor impaired . . .

. . . but very, very funny is this spoof from the folks who bring you The Onion. (Bragging moment: My neighbor's son is the managing editor of The Onion. Go Pete!)



*Thanks, Kay, for the link!

And now for something beautiful

My amazing husband, Jamie Young, has a simply gorgeous photo featured on this website. It's called "In a Dream" and was taken at Chimney Bluffs State Park in New York.

You gotta love a guy who can do this.

Not just docked but dumped

As a follow-up to my earlier post about being docked for being overweight, now it turns out you can be turned down for health insurance altogether, as reported in this article from the weekly alternative newspaper in my town. And wouldn't ya know it--my new employer's health insurer is Humana. (And so far they, um, are living up to their reputation.)

Please tell me this isn't happening . . .

At least one health insurer (and probably others) will actually be docking your paycheck if your BMI is over 30, starting in 2009.

The article's headline reads "Being Unhealthy Could Cost You--Money," but of course it should have read "Being Fat Can Cost You--Money." And that's on top of it costing you so many other things--the right to adopt a child, a seat on an airplane, a job. . . .

I wish I were a lawyer so I could start researching all the ways in which this is illegal. A nice big lawsuit--maybe a class action suit--might nip this repulsive idea in the bud.




**Thanks to BFB for posting on this first.

And another Leaden Fork award goes to . . .

Apple, for the revolting tagline promoting the new iMac:

You can't be too thin. Or too powerful.

News flash to Steve Jobs and his marketing department: You sure as hell can be too thin. Your hair can fall out. You can be cold all the time. Your heart can slow down. You can become psychotic on the subject of food. In fact, you can be possessed by an illness so powerful that it actually causes you to violate the most basic human instinct: self-preservation. You can be so thin that you actually commit suicide by starving yourself, while in the grip of a delusion so powerful that neither reason nor logic nor love and empathy from others can touch it.

If you want to step inside the mind of someone who is too thin, read this. I hope you weep.


**Thanks to Cynthia for the link.

Leptin babies, redux

Now the New York Times has taken up the idea of lacing baby formula with leptin to create children who are permanently unable to become fat.

I posted about this back in May, when the research on this first appeared. And I haven't changed my mind. Haven't we done enough damage by our relentless pursuit of thinness? Do we really think creating a generation of children whose bodies are permanently and deliberately made inefficient is a step forward? What if those children should find themselves in a situation where they need some nutritional reserves? What if they develop anorexia? Imagine the hell of trying to re-feed a child who is physically unable to gain weight. And what about when those children grow old, at a time in life when being "overweight" is correlated with having the lowest mortality risks? Maybe thin won't look so hot when it's a life--or death--sentence.

Maybe someday we'll stop confusing aesthetics with health. Yeah, right. And maybe someday I'll be president of the United States.

Another step toward mental health parity

From an e-alert sent out by the Eating Disorders Coalition (EDC):

Senate Agrees to Remove Barriers to Mental Health Coverage
Republican senators this morning removed language from the Senate's parity bill that would have made it more difficult for people with eating disorders to get treatment under many health insurance plans. The senators heard from business leaders and insurance companies, who last night decided to strike the preemption section of the Mental Health Parity Act of 2007 (S 558). Mental health advocates believed that the preemption clause would weaken the parity bill, leaving it up to state laws to determine whether eating disordhttp://www.blogger.com/img/gl.link.gifers would be covered.

"This is a huge step forward," said EDC President Kitty Westin. "It shows that our work is paying off. It appears that the Senate will vote on parity this afternoon before the summer recess begins. If that happens, then mental health parity will probably be on top of the House agenda in early September, when Congress returns."

The EDC has actively supported the House and Senate bills.


What happens next?

The Energy and Commerce Committee of the House of Representatives will probably vote in early September on the House parity bill, the Paul Wellstone Mental Health Equitable Treatment Act of 2007 (HR 1424).

What can you do?

If you are represented by a member who serves on this committee, call, write, or visit the member in August and explain why you think mental health parity is needed. Most members are spending much of August in their home districts, close to where you work or live.

HOUSE ENERGY & COMMERCE COMMITTEE

John D. Dingell (MI), Chairman

Democrats Republicans
Henry A. Waxman, CA Joe Barton, TX, Ranking Member
Edward J. Markey, MA Ralph M. Hall, TX
Rick Boucher, VA J. Dennis Hastert, IL
Edolphus Towns, NY Fred Upton, MI
Frank Pallone, Jr., NJ Cliff Stearns, FL
Bart Gordon, TN Nathan Deal, GA
Bobby L. Rush, IL Ed Whitfield, KY
Anna G. Eshoo, CA Barbara Cubin, WY
Bart Stupak, MI John Shimkus, IL
Eliot L. Engel, NY Heather Wilson, NM
Albert R. Wynn, MD John Shadegg, AZ
Gene Green, TX Charles W. "Chip" Pickering, MS
Diana DeGette, CO, Vice Chair Vito Fossella, NY
Lois Capps, CA Steve Buyer, IN
Mike Doyle, PA George Radanovich, CA
Jane Harman, CA Joseph R. Pitts, PA
Tom Allen, ME Mary Bono, CA
Jan Schakowsky, IL Greg Walden, OR
Hilda L. Solis, CA Lee Terry, NE
Charles A. Gonzalez, TX Mike Ferguson, NJ
Jay Inslee, WA Mike Rogers, MI
Tammy Baldwin, WI Sue Myrick, NC
Mike Ross, AR John Sullivan, OK
Darlene Hooley, OR Tim Murphy, PA
Anthony D. Weiner, NY Michael C. Burgess, TX
Jim Matheson, UT Marsha Blackburn, TN
G. K. Butterfield, NC
Charlie Melancon, LA
John Barrow, GA
Baron P. Hill, IN

No, it's bad news

A couple of days ago I posted about a new study out of Finland showing that anorexia is both--as the media are reporting it--"more common and more transient than previously believed." It took me a few days, but I finally figured out what's bugging me about this: the word transient.

Transient is something that happens for a hour or two and then disappears. Transient is fleeting, momentary, temporary.

Transient is not what happens when the demon of anorexia inhabits someone, body and mind and soul, for three or five or seven years. Transient is not losing most of your adolescence and some of your young adult years to a disease that's like an eclipse of the world-as-you-know-it.

Transient is when they close the street to do construction repairs. Transient is not when the street gets blown up. Even if it gets fixed five years later.

One thing I've learned from Sandy Szwarc is to look behind the rhetoric when it comes to studies and research findings. In this case, it's the interpretation, I suspect, that's bugging me. I don't know if it's the study's authors, or the media reporting it, or both. All I know is that anything that puts a child into hell for longer than an hour or two is not transient. Not at all.

Et tu, Dick Cavett?

My evolution from wannabe-thin-person to fat activist has been a long time coming. And I've lost a fair number of friends along the way, mostly people who for one reason or another could not, cannot accept the fact that people come in all shapes and sizes. Call it fatphobia, call it thin entitlement, call it self-loathing, call it prejudice of the rankest sort. Whatever you call it, it all boils down to judgmentalism.

So I don't know why Dick Cavett's rant in his New York Times blog should feel so especially and particularly mean-spirited and judgmental, but it does. Maybe because I used to like Cavett's TV show. He was witty in a way few other TV hosts were back then. So to have him tell the world now that, 1) it's not OK to be fat, and 2) fat people are "heavily larded folks", and 3) obesity is a "national tragedy," well, it feels like a betrayal.

It's the same feeling you get when you meet one of your favorite writers and he turns out to be an asshat. A nasty asshat who snarls at you, or--and this has happened to me--a sexist asshat who pats you on the head, calls you "doll," and asks for a cup of coffee.

Either way, it's like peeling off the jovial mask and seeing the hard face underneath.

And that's pretty much what Dick Cavett has done. To himself.

Mr. Cavett, you want to see ugly? Take a long, hard look in the mirror. Being thin does not mean being healthy. Being thin doesn't mean being attractive. Especially when such mean-spirited ugliness comes out of a thin person's mouth.

Anorexia: Bad news, good news, bad news

The bad news: A new study from Finland reportedly shows that anorexia is about twice as common as researchers have thought, affecting about 5 percent of the population rather than the 1 to 2 percent incidence rate generally quoted. According to the study's authors, this statistic includes mild and/or subclinical cases not usually counted—people (most of them women) who suffered from "mild symptoms" (the news reports don't say what these are).

The good news: According to this study, about 70 percent of anorexics recover. By contrast, the usual statistics say that about a third of anorexics recover fully, a third remain very ill, and another third stay right on the edge, living a sort of half-life. The mortality rate is 20 percent.

The bad news: That 70 percent of women who recover do it "by age 30," says the study. Given that the average of onset for these women is between 15 and 19, that means they're still sick for many years.

One thing I like about the study is that it describes the arc of recovery in a helpful way: "First, lost weight was regained and menstruation resumed. Attitudes about body shape and weight took a much longer time to resolve. The Finnish study was conducted among pairs of female twins. Twins with anorexia nervosa were compared to their healthy co-twins and to healthy women from the general population. Within five years from weight restoration, women with anorexia nervosa were virtually indistinguishable from their healthy co-twins in terms of psychological symptoms and self-esteem. However, learning to deal with body shape and weight related concerns took usually much longer, 5-10 years."

Still too long. But heartening to know that at least studies on anorexia are starting to funnel down the pipeline.

Maybe the best commentary on the "obesity is contagious" study

And this commentary was published in Poland, where I have no idea what the popular stance is on issues of fat and thin.

Whoever this writer is, s/he gets it and has fun with it. So read up.

Time to spread the love!

My fabulous web designer, Gale Petersen, made a PDF of the I Love My Body! pledge. Yay! So now you, too, can download and disseminate the pledge. Post it at work. Email it to teachers and Girls Scout troop leaders and guidance counselors and parents. It's so easy for us to hate ourselves and our bodies--let's spread a little love instead!

And if you do send the pledge around, I'd love to hear about your experiences with it.

Coming soon: Big Brother is watching you--eat

You've no doubt read about the this article in the New York Times by Gina Kolata, in which she covers the "fat is contagious" study published in the New England Journal of Medicine.

As a fellow journalist, I understand that Kolata had to cover the story. An obesity reporter's gotta cover what an obesity reporter's gotta cover (which is why I left the world of hard news long ago). But the tone of this article is a little too uncritical in my opinion, a little too quick to accept the study's dubious findings as valid research.

The quote that sent me reaching for my keyboard: When a close friend becomes obese, obesity may not look so bad. “You change your idea of what is an acceptable body type by looking at the people around you,” Dr. Christakis said.

In other words, size acceptance causes obesity.

I'm not even going to try to unpack all the assumptions here. Like, for instance,the fact that thin people can become fat, or that fat is always Bad with a capital B, or that it's better to be thin than to be comfortable with yourself, whatever your size is. And then of course there's the fact that these researchers don't seem to understand that--repeat after me, class--correlation does not equal causation.

Kolata certainly didn't try. She appears to have reported all this with a straight face, more or less, despite her considerable knowledge about obesity and scientific research and, well, bullshit.

Gina, Gina, Gina. I may have to take your book off my shelf.

Ellyn Satter's rules for eating

The incomparable Ellyn Satter has posted another newsletter to her website, this one (like the previous two) geared toward helping pregnant women figure out how to eat well despite the growing pressure to not gain much weight during pregnancy.

But these rules apply just as much to those of us who are not (and never will be again!) pregnant, so I'm taking the liberty of summing them up here. Then go read the whole thing yourself.

• Encourage each woman to be positive and reliable about taking care of herself with food
• Emphasize pleasure as a guiding principle in food selection
• Teach and support internal regulation of food intake
• Teach and model body trust

Great rules for mothers-to-be, both to help take care of themselves and to make sure that their attitudes toward food and body image are in good shape as they begin the process of raising the next generation.

If only more clinicians and researchers felt this way.

What is normal?

Not long ago, I had the privilege of being asked to do a radio commentary for a wonderful NPR show called To the Best of Our Knowledge. It aired on June 16 in a show called "What Is Normal?" which includes, among other things, a fascinating description of the Amish ritual of Rumspringa.

My piece was about the difficulty of knowing whether my 14-year-old daughter was going through the "normal" pangs of adolescence or something more serious. If I could figure out how to post the MP3 file here, you could listen to it. Or you can go to to the website and listen to it here. It's a cool show. My piece comes about 24 and a half minutes in.

Now it's women who work who cause obesity

At least according to this article from across the pond, which cites a correlation between between working mothers and obesity that is so specific, it's laughable. According to researchers at the UCL Institute of Child Health in Scotland,

children are more likely to be overweight for every ten hours a mother
worked. This risk increases in the highest-earning families.

They theorize that children of working mothers "have less access to healthy foods and physical activities."

You've gotta admire those obesity researchers--they can find a risk factor in just about anything.

J.K. Rowling and fat acceptance

I love J.K. Rowling. Not just because she's an author of tremendous imagination, heart, and soul, but also for the fat rant that appears on her website. (Thanks to anonymous for the correct link.)

What we know about fat and thin

In response to an anonymous comment made on my last post--don't you love people who attack behind an "anonymous" handle?--I want to clarify a few things about fat and thin.

The biggest cause of fatness is genetics. Heritability for obesity is .7, according to this article in the Proceedings of the Nutrition Society published by Cambridge University Press.

Upward of 90% of people who diet to lose weight gain the weight back and then some. So . . .
Diets don't work.
And . . . when diets don't work, they make people fatter.
Calories in do not equal calories out. (Contrary to anonymous' assertion, this concept does not defy the laws of physics; it's a function of metabolism, which is not uniform from person to person, and which is affected by a wide variety of factors. This not something that I "somehow think"; it's been observed over and over by scientists far more knowledgeable than I.)
Fat people tend to stay fat. (See Kolata.)
Thin people tend to stay thin. (See Kolata, Sims, Minnesota Starvation Study.)
Obesity appears to put people at risk for diabetes.
The relationship between fat/obesity and mortality is much more complicated than fat = bad, thin = good.
The current "moral panic" over fat hangs on a "health and wellness" peg but actually derives more from aesthetics than true health.
Even if we all agreed that fat was bad, we don't know how to make people thinner. See point #1.

And finally:
Fat haters have a lot in common with racists. They may cloak their arguments in other terms, but the bottom line is that they see fat people as ugly second-class citizens who don't deserve to be happy, healthy, or whole.

Now, that's ugly.

The fat wars and eating disorders

I was going to post this as a comment to the last post, but I feel it needs its own thread here.

I'm so sick of hearing that "eating disorders affect a tiny percentage of the population, but obesity kills thousands."

There is ample evidence that obesity does not kill anywhere near the numbers originally released by the CDC. But that's not where I want to go with this today. Even if it were true, this attitude makes me sick. It's like saying, "Losing a few people to e.d.s is worth it, if the rest of the fatties shape up and lose weight."

As some of you know, my daughter almost died of anorexia, an eating disorder that has the highest mortality rate of any psychiatric illness--up to 20%. It's true that diagnosed eating disorders affect only a small percentage of the population—but they are a very real and very significant problem. Especially if it's your child, your niece, your best friend's daughter.

The argument over whether fat is unhealthy or not is not merely an exercise in fat-bashing and prejudice. If it were, well, as someone said earlier, we could indulge in it until the amusement factor wore off and then be done with it. But there are real, heart-breaking consequences to this. And one is that we are now seeing an unbelievably rabid set of anti-fat messages directed at a vulnerable population: kids ages 8-15. Middle school is a time when just about every kid is horribly self-conscious about bodies to begin with. It's also the average age of onset for eating disorders--in the 13 to 15 range. I think we're going to see a rise in anorexia and bulimia as a direct consequence of this messaging. Anecdotally, I know of many families (including my own) whose eager-to-please children started trying to "eat healthy" in middle school and for a variety of reasons (including genetics) went too far and wound up with AN or BN. For those who are susceptible, this kind of pressure will certainly trigger eating disorders.

So this isn't an academic exercise. There is and will continue to be a very real fallout from the "just eat healthy" messaging. Children, families, and adults will suffer. If you've never really known someone with an eating disorder, let me say that you have NO IDEA how much that person suffers. And not just that person, but their family, and friends. Having anorexia is like living with a demon inside you that torments you 24 hours a day, 7 days a week. There is no vacation from e.d.s. They take over your life. You have no life outside them.

And too many of these sufferers will die. Yes, die from eating disorders. And these young women and men are not negligible. They're not collateral damage in (yet another) stupid, ill-advised, mismanaged war. They are our daughters and sons. And I say, enough.

The fat wars

Deja Pseu's thoughtful, informative comment on my last post inspired me to start a new thread, which I've been thinking about all day, between reading and responding to comments here.

Deja asks why it's so much easier for people to accept the realities of a fast metabolism than a slow one. Good question. I think it's like the "career women" (in quotes because that was how they were known at the time) of the 1950s and 60s, at a time when most women didn't have careers outside the home. They were the women who made it by playing hardball with the boys, by becoming one of the boys. They paid dearly for their corporate successes, and they were considered freakish by the cultural norms of the time.

Those women were harder on the next generation of striving career women than any men. Their attitude was, "I had to suffer, sister, and by God, so do you."

And that's what Deja's question, and the whole notion of fat wars, reminds me of. In a culture where thinness confers status, and fatness confers untouchability, of course those who have it, who are thin, will hang on to their notions about it forever. To acknowledge that fat and thin are largely functions of genetics would be to give up that special status. And if you're not a naturally thin person, and you've practically killed yourself getting and staying thin, well, it's human nature to want others to suffer right along with you, isn't it?

Depressing thought.

The war on fat, in someone else's words

I won't say where I found this, but this post was written in response to someone raising the question of whether, perhaps, obesity might not be a completely evil phenomenon:

"Obesity is unhealthy. There is no doubt about it. It increases the risk of high blood pressure, heart disease, diabetes (and subsequent problems with high blood pressure, kidney disease, and major foot problems, including multiple surgeries and amputations), stroke (partly secondary to the high blood pressure), arthritis (from the sheer weight on the joints), plus other medical and psychological problems. When it is also combined with smoking, which it often is, there is even more disaster.

It is a huge expense to society to have so many obese people with their medical problems. It is a preventable disease. People just need to eat less and exercise. They need more self-control.

To flaunt it as a nonpreventable problem is just not true. What has changed during the past 50 years is that people eat more and move less. Obese people want respect for their eating problems and acceptance. I think that as long as other people are able to control themselves and discipline themselves to exercise, then there will be contempt for those that cannot.

Also, I think that a lot of people resent the high cost of obesity. Health care would be a lot less if people just didn't eat double bacon cheeseburgers, fries and a Coke, then go out for ice cream or beer, and then sit and watch TV (or drink more beer, which has a lot of calories.)

Personally, I resent so much money being spent for accomodations and gastric stapling/bypass surgery because people want to gorge themselves constantly with fatty food!"

It's rare to see so many misconceptions and such hatred right out there in the open. Next you'll be telling us that fat people are responsible for global warming.

Personally, I resent the millions of dollars being wasted on ill-directed and ineffective "wellness" campaigns in schools and offices. And I resent the hell out of the ignorant assumptions behind your words.

So I'm going to exercise tremendous self-restraint (and you know how hard self-restraint is for a fat person!) and recommend that you educate yourself rather than simply parrot the anti-obesity rhetoric of our time. Start by reading Gina Kolata's new book, Rethinking Thin. Kolata is a well-respected New York Times science writer. She is also, if it matters to you--and I think it does--a thin person.

Then I'd suggest reading a little Paul Campos--he's also a thin person, though formerly fat. Then read this post at Kate Harding's fantastic blog.

Then come back and tell me how you feel about fat.

News flash: obesity is not a public health crisis

This somewhat circuitous essay by Jay Bhattacharya caught my eye. Bhattacharya is an M.D. and all-around policy wonk at Stanford University's Hoover Institution on War, Revolution, and Peace. (Great name!)

Don't be put off by the offhand judgments Bhattacharya seems to be making early on; the essay becomes more thoughtful as it goes along. His basic premise: obesity is not a public health crisis because it's not contagious, harms only the person him or herself and not others, and, maybe, is not under an individual's control. He makes an interesting point about why fat workers earn less money than thin ones (not because of prejudice, he argues, but because employers "pass through" higher health costs to fat employees); according to Bhattacharya, only fat workers with health insurance earn less. Among those without health insurance, there is no wage gap.

Interesting, but I wonder if the real reason is that the kinds of jobs that don't come with health insurance are so poorly paid that there's no room for a wage differential. Twenty percent less than $20 an hour is significant; 20 percent less than $5 is less so.

The best paragraph in the essay is the last, where he makes a compelling case against setting public policy after jumping to conclusions. Worth a read.

Just for fun--put on your dancing shoes!

Today's New York Times had a story on contradancing and country dancing in the Big Apple.

When I lived in New York City--from 1979 to 1992--this was my subculture. I loved dancing at the church at 13th and Seventh on Tuesday and Saturday nights. It makes me happy to know the dances are still going on. The Times story quoted someone I used to know in the dance scene in New York, Olivia Janovitz. (Hi, Olivia!)

In those days I belonged to a women's sword dance troupe, too. We did things like this.



I miss it! And them.

Self-esteem

Yet another star (in this case, Valerie Bertinelli) is writing a memoir about, among other things, her "lifelong battle with weight and self-esteem."

She's talking about overweight, in this case, and it all sounds so damn familiar: Low self-esteem makes people get fat. It's the same rhetoric that floats around anorexia, which is so often said to be linked to issues of self-esteem. Apparently it works both ways, or both weighs.

Inquiring minds know the truth: Starvation causes all kinds of psychological phenomenona, including depression, anxiety, and, yes, low self-esteem. And being fat in America is an invitation to feelings of worthlessness, inadequacy, and low self-esteem. All you have to do is walk down the street and it flies right at you. Or go to your mother's funeral. Or try to adopt a child.

For once I wish people would get it right. I wish they'd lay the blame squarely where it belongs. In the case of anorexia, that's on biology. And in the case of fat--that's called prejudice.

At risk for what?

This just in: Experts are now urging women to watch their weight before pregnancy and get back to their pre-pregnancy weight quickly after giving birth. Their new recommendations include:

* Body mass index should be measured as part of vital signs at routine annual check-ups and all women of child bearing age should be counseled to achieve and maintain optimal BMI.
* Preconception counseling programs should include education regarding the poor maternal and perinatal outcomes among the obese and overweight.
* Women with high BMI planning a pregnancy should be counseled to participate in intensive nutrition programs aimed to achieve optimum BMI prior to conception.
* Encouraging breastfeeding can partially help to decrease childhood obesity and also help mother to return quickly to pre-pregnancy weight.

Why the panic? Because, say these researchers, "maternal obesity" leads to all kinds of terrible things for babies, including higher C-section rates, "less chance" of being breastfed, obesity later in life, and--I kid you not--"high birth weight."

And here I thought low birth weight was the big risk when it comes to babies and weight. After all, low birth weight can contribute to respiratory problems, cardiovascular problems, infections, neurological problems, SIDS, cerebral palsy, and other medical issues.

But never mind all that. As we should all know by now, it's much worse to be fat than any of those.

I guess they never heard of genetics, and have never read the dismal statistics on weight loss, or followed the studies that show that losing weight if you're fat actually increases your health risks on many levels.

As Sandy Szwarc pointed out in a recent post, there are people who think you can be too fat to love a child. I guess you can be too fat to have a child too.

Tornadoes on NPR

Want to hear a funny story? This radio commentary—on surviving my first tornado—ran on All Things Considered today. Let me know what you think.

Take the love-your-body pledge

The previous post, and some of the comments on it, got me thinking hard about how to begin to change the culture around fat and how we perceive it.

I asked myself: What's the one thing I wish I could change around this issue? The answer: I wish I could change the way girls and women talk to themselves and others about their bodies.

I've posted about this before. And I've written about it in this article. Now it's time to do something about it.

So I have this crazy idea: What if we could disseminate a kind of pledge that young girls and women would sign, promising not to trash-talk about their bodies? Something like this:

I, __________________, pledge to speak kindly about my body.

I promise not to talk about how fat my thighs or stomach or butt are, or about how I really have to lose 5 or 15 or 50 pounds. I promise not to call myself a fat pig, gross, or any other self-loathing, trash-talking phrase.

I vow to be kind to myself and my body. I will learn to be grateful for its strength and attractiveness, and be compassionate toward its failings.

I will remind myself that bodies come in all shapes and sizes, and that no matter what shape and size my body is, it’s worthy of kindness, compassion, and love.


Then what if we got some of their favorite role models to sign, and stand up and say why it's important? Folks like, I don't know, Sheryl Crow and Jennifer Hudson and Mia Hamm? Would you sign it?

See, I think sometimes if you change the story you tell yourself about something, your feelings follow along. So maybe if we change the words we use to talk about our bodies, our feelings about them will follow along too.

And then maybe kids like the 12-year-old in my previous post won't feel so anxious and conflicted about what they eat and how they look. And maybe some of the kids who are genetically predisposed to eating disorders won't develop them.

Maybe it's naive. Or maybe it's a good idea. What do you think?

Overheard at the lunch table

Recently I had occasion to take my kids on an all-day excursion, to which they were allowed to each invite a friend. As we cruised the lunch joint we'd chosen, the 12-year-old friend seemed, well, anxious about what to choose. She wanted nachos, she said, but that wasn't healthy. (Sound familiar, anyone?) Her parents, she explained, have a rule about eating fruits and vegetables at every meal. She finally settled on nachos and a container of cut-up fruit. "My father says I don't eat enough for a girl my age," she commented. Gee, I wonder why; could she be learning from them to be afraid of food? If she has the genetic loading for an eating disorder, she's in big trouble.

As we ate, the conversation turned to a new movie, Ratatouille. This girl had seen it. "I really liked it," she reported, "except for all those rats who were so fat!" Then she went on: "It's so disgusting! They had all these bulges of so much fat!"

I was fairly stunned, but only because she was articulating what I know so many people think. I didn't know what to say, honestly, and what came to mind wasn't great: "In our family we don't feel fat is bad. People come in all shapes and sizes."

"But all they have to do is eat less and eat healthy and they wouldn't be fat!" she cried. Out of the mouths of babes, huh? "That's not actually true," I said, and then changed the subject, feeling like a coward. But I really didn't feel like taking it on, especially since I could see she was just parroting what she'd heard at home.

Later in the day, everyone else got ice cream, and so, I was happy to see, did she. The fruit went home unopened. For what it's worth.

Seeking adults with anorexia for interview

I'm working on a magazine feature for HEALTH magazine about adults with anorexia and am looking for women in their 30s and 40s who would be interested in being interviewed. The original scope of this project was on people who developed anorexia as adults, but it's now changed to women who are still suffering from anorexia as adults, no matter when they developed it.

If you fit the criteria and you've already talked to me, please get in touch again--I lost my records in a computer crash.

If you're willing to talk by phone, please email me off list. I promise it's a sensitively written article, the purpose of which is to help educate mainstream readers about anorexia. God knows they need it!

Anorexia on NPR

A friend called over the weekend to say that she'd been listening to this interview with the author of Peony in Love when she heard interviewer Liane Hansen make a comment about anorexia that made her blood boil. The author was describing lovesick young girls in 17th-century China. Hansen's comment, which comes about 4.15 minutes into the interview:

"It is interesting, the lovesick young ladies that are affected by the opera, what happens to them in their lovesickness is they starve themselves. And that's so much like anorexia, where you have young women today, and young men, starving themselves because that is the only way that they have some control over their own body."

Dear Liane Hansen, you may be an expert on so many things, as your NPR bio indicates, but anorexia is not one of them. Your throwaway comment about anorexia was made out of ignorance rather than malice, I'm sure. But ignorant it was.

Most researchers today believe that anorexia is a biologically based brain disorder. It's not "about" control. It's not "about" bad parenting, any more than autism or schizophrenia are. In fact, it's not "about" anything at all except having the bad luck to be genetically predisposed and to live in a culture full of triggers.

You have a lot of influence, Liane Hansen. I hope you will take this opportunity to educate yourself about anorexia. This website and this website would be great places to start. Then give me a call--I'd love to talk.

PETA's fat-hating frenzy

The folks over at PETA have a gripe with filmmaker Michael Moore: they want him to make a documentary about animal rights.

That's cool. But the way they go about airing their gripe--very uncool.

The president of PETA, Ingrid Newkirk, wrote an open letter to Moore last week, which was publicized on PETA's blog. In it, Newkirk urges Moore to go vegetarian:

"Although we think that your film could actually help reform America’s sorely inadequate health care system, there’s an elephant in the room, and it is you. With all due respect, no one can help but notice that a weighty health issue is affecting you personally. We’d like to help you fix that. Going vegetarian is an easy and life-saving step that people of all economic backgrounds can take in order to become less reliant on the government’s shoddy healthcare system, and it’s something that you and all Americans can benefit from personally.”

PETA's blog goes on to say, "The idea is that if people didn't make themselves unhealthy in the first place by eating meat products that are known to cause heart disease, high blood pressure, and strokes, the situation would easier for everyone. As Ingrid puts it, 'Yes, America’s health care system needs to be fixed, but personal responsibility is a big part of why people look and feel as ill as they do.'"

Take that, Michael Moore! It's YOUR fault if you get sick—and so is the whole crappy health care system in America!

Hoo-wee! It's great to feel powerful, isn't it?

Note to Ingrid Newkirk: Go have a doughnut or something.

One more reason why I'm a fan of family-based treatment

There are very few follow-up studies (or heck, any studies at all) of anorexia treatment, so I was glad to see this one, done in Norway a couple of years ago. I wasn't so glad of its outcomes.

The study was a one-year followup of adult anorexics who'd been treated on an inpatient unit. Of the 24 patients they followed up with, 10 (42%) had improved one year later, while 14 (58%) had "poor outcomes."

I'm grateful that they did the study, frankly, because most of the numbers on inpatient anorexia treatment come straight from the clinics and units, which often stand to make a tidy sum on treatment. Their followups are usually done at discharge, so they don't take into account what almost always happens after that: relapse and rehospitalization.

So bravo to the researchers in Vikersund. And chalk up another reason why family-based (Maudsley) treatment is an excellent option for anorexia.

"Who *doesn't* want to lose 20 pounds?"

That's what ex-supermodel Rachel Hunter said in New York magazine about her new gig as spokeswoman for Slim-Fast. She was admitting that she'd never tried it.

This kind of fat trash talk is my least favorite. It's the equivalent of the air kiss, the baring of the throat by the subordinate animal. It's a social custom denoting (supposedly) good taste and submissive femininity. The words themselves aren't the point; it's the intention behind them. And the intension is to erase the self, to make yourself as small and thin and weak as possible.

20 pounds = the weight of 7 brains
20 pounds = the weight of my older daughter at age 11 months
20 pounds = the number of pounds I lost on my first diet, age 15
20 pounds = the number of pounds I lost on my last diet, age 29
20 pounds = the amount of weight lost by my mother in law in the month before she died of cancer

But who doesn't want to lose 20 pounds?

**Thanks to Maggie! for sending this item my way

Another book the world doesn't need--gulp!

Thanks to Kate Harding for posting about the latest entry in the fat hatred sweepstakes--a joint project from two of my former favorite children's book authors. The book is The Gulps, and it features a lazy, gluttonous family who are constantly eating junk food and watching TV. Just like all the fat people I know in real life!

The Gulps was written by Rosemary Wells and illustrated by Marc Brown (of Arthur fame). May it die a speedy, painful death and be remaindered as quickly as possible.

This is what dieting can lead to

This excerpt from a brave, honest livejournal entry, addressed to the "pro-ana" contingent, made me cry. Of course not everyone who diets will become anorexic. But everyone who becomes anorexic goes through this. It's heartbreaking. It's lifebreaking.


"I have anorexia.

Not 'pro-anorexia,'
Not a strict weight loss obsession.

The last 6 months of my life have been hell.

I have watched everything I love slowly deteriorate around me, my own little world be turned completely on its head. I have damaged myself beyond repair and hurt those i love time and time and time again.
And I cannot control it.
Because it is a disease.
It is a condition.

And right now, it's very very bad for me.

I cannot express my frustration with those people who exploit the anorexic condition by using it to starve themselves as a weightloss strategy.
I want to eat.
I want my life back.
Anorexia stops me.
I'm fighting it, but it's hard. the hardest thing I've ever done.
How dare you all, sit there and wish for this.
Get out now while you can.
Please. I wish I could."

More research on anorexia . . . I think

I'm a big supporter of more research about anorexia. If you've read my blog or articles you know I think one of the reasons we don't have better treatments is lack of good research. So I'm always excited to see a new study come out.

I have to admit, though, that the title of this one--"What is worse for your sex life: Starving, being depressed, or a new baby?"--reminded me of the kinds of questions you ask your friends when you're in middle school, like "Which would you rather do, burn to death or freeze to death?"

Still, I guess it's a good thing to have the redoubtable Cynthia Bulik involved in a new study, whatever the topic. After all, she's at the forefront of the research on the genetics and biology of anorexia.

Oh, and if you're wondering, the answer to the question the study poses is that it's better to have a new baby.

Shame on you, Dear Abby

I'll cop to reading Dear Abby, despite the often off-the-mark advice she doles out. But today's column went beyond off-the-mark and into just-plain-dangerous-and-wrong territory.

Here's the letter in question: "I'm an attractive, single, successful, 27-year-old woman who has struggled with anorexia ever since I was 12. I have learned to live with it and feel no need to advertise it to the world. However, I find that many strangers, including a large number of people I associate with at work, feel a compulsion to comment on my weight (105 pounds and 5 foot 9), the size of the clothes I wear, or what I eat. It's as uncomfortable a subject for me as I imagine it is for people who are overweight, and I have no 'pat' answer for them." --Annoyed at 105

Here's Abby's response:
Dear Annoyed: Clearly, your weight issues are more obvious to those around you than you chose to believe. However, you are under no obligation to answer these intrusive questions if it makes you uncomfortable. When confronted, reply, "That's a very personal question (or subject) and I'd prefer not to discuss it." Then change the subject.


Argh! Please write to her and set her straight about anorexia: It's not a "lifestyle choice" but a lethal mental illness. Ask her why she would sanction this writer's settling for a life distorted by anorexia. Invite her to list resources that might be helpful to "Annoyed" and her family, including maudsleyparents.org, NEDA, eatingwithyouranorexic.com, and others.

This is a teachable moment on a national scale. Go for it!

Couldn't resist this one, either

Check out this satire on all the "war on obesity" news of late. Hee hee.

Because I can't resist . . .

You won't be able to, either. It's a musical love letter from a young Brit to the "big girls," and it really rocks!

"Fitnessgrams" for kids

My 11-year-old daughter's report card came in the mail today. Along with the usual list of academic subjects and grades came another piece of paper with a big orange bar at the top. In blue blue letters it read FITNESSGRAM. Below was a graph of how my daughter had performed on a series of fitness tests, including a one-mile run, abdominal curl-ups, trunk lifts, push-ups, and flexibility. Then there was another little box labeled "Body Mass Index," showing her past and current BMIs plotted against a bar graph. Her scores were in the green "healthy fitness zone." To the right was a large red area--danger! fatsos coming!--labeled "Needs improvement." That's where your bar graph ends up if your BMI is "too high." To the left was a tiny red box labeled "very low," which is, I suppose, where your bar graph ends up if you're anorexic.

I guess this is supposed to be a cute, non-threatening way of communicating with parents, a kind of casual, unofficial, "Say, did you know your kid's in great shape?" or "Hey, by the way, your kid's kinda fat!"

This is insulting on any number of levels, of course, but let's just pick one: the suggestion that it's better to be too skinny than too fat, which as we know is not supported by any actual science.** Why isn't the "too skinny" area labeled something like "needs medical attention now!"? Why isn't the "too fat" area labeled "plenty of nutritional reserves!"?

My daughter was more upset about the fake activity pyramid on the back of the fitnessgram, modeled after that most famous of irrelevancies, the USDA food pyramid. At the bottom, the widest section was labeled "lifestyle activity," and it listed walking, biking, skateboarding, housework, yardwork, dancing, and playing active games. The next level held two smaller squares labeled aerobic activity and aerobic sports. One level up, another two squares were labeled muscular activity and flexibility activity. The smallest section, the point of the pyramid, was labeled "rest," and it included schoolwork, homework, reading, computer games, TV, videos, eating, resting, and sleeping.

Clearly these are the things you're supposed to do as little of as possible. My daughter was outraged. "I wonder what the teachers would think about this!" she cried. "You're not supposed to read?"

Imagine boot camp. Then imagine a sergeant from boot camp running the schools. "You there, cadet, stop wasting time with your nose in a book and give me 50 on the floor!" Never mind the fact that kids are supposed to be developing their intellectual capabilities at this (and every) age; in the new Fitness World, only activities that burn calories are sanctioned. Even by schools.

I feel like we're living in a Kurt Vonnegut story. And it's only gonna get worse.


** Calorie reduction (CR) nutcases notwithstanding.

Why dieting is the ultimate health risk

Big kudos to Sandy Szwarc, whose most recent post looks at how the American Heart Association's "heart-healthy" diet recommendations don't actually add up to better health or longer lives for women.

Eating healthy, in other words, doesn't protect you from heart disease. (We're talking about women who aren't sick; the statistics are different for those who already have heart disease.) And eating "not-healthy" doesn't put you at higher risk--at least, no studies have been able to show a cause and effect relationship.

In fact, all "eating healthy" (read: dieting) does, as we know, is make you fatter by messing up your metabolism with the deprivation-and-binge cycle. So dieting itself is a risk factor for obesity.

Obesity, it turns out, is a risk factor for diabetes, but not much else. Fat people actually do better after heart attacks than thin people. Older people who are fat live longer than their skinny peers.

Another thing dieting does is trigger eating disorders in those who are susceptible. Once more, dieting itself is a risk factor for anorexia, a serious illness that kills up to 20% of those who suffer from it.

Oh yeah, it does one more thing: Make money for the multi-billion-dollar weight loss industry, for the bariatric surgeons, and for the obesity researchers. Cui bono, baby?

So forget the war on obesity, which is as ill-conceived and well-funded as the war in Iraq. I think we need a war on dieting.

**This post is dedicated to the memory of my dear friend Marilyn "Mimi" Orner, who founded the Anti-Anorexia/Bulimia/Dieting Project. She was an advocate of size acceptance, a survivor of anorexia, and a powerful inspiration to a generation of young women. She died of ovarian cancer in 2000 but has not been forgotten. You still rock, Mimi!

How can you tell if your child is developing an eating disorder?

Go here to listen to my radio essay on the subject, which aired today on "To the Best of Our Knowledge." The essay aired as part of the show dated 6/17/07.

Fat--it's all in your head

At least according to this editorial in the American Journal of Psychiatry, exploring the question of whether to make obesity a brain disorder in DSM-V.

Of course, it's not really clear what exactly they mean by brain disorder. Anorexia and bulimia are listed in DSM-IV as brain disorders, sorta, and I have to say, I'm not sure what that means, either. Insurers still treat them as mental health issues rather than biologically based illnesses, and use that as a way to skive off covering them (at least in beknighted states like Wisconsin, which have no mental healthy parity laws).

It depends what the rationale is here, really. What we now know about eating disorders like anorexia is that some people are genetically and biologically predisposed to them, and that environment seems to play some kind of role in triggering those who are susceptible. Maybe that's true for obesity. That makes more sense to me than suggesting that all so-called obese people are compulsive eaters, which we know ain't true. Yo-yo dieting might be the environmental trigger, resetting the metabolism over time in ways that result in obesity.

But if an entry in DSM-V is going to result in more stigma attached to being obesity, I think we should say no thanks.

What do you think?

The obesity paradox

Thanks to fat fu for pointing me toward this article on the so-called obesity paradox. It reads like something straight out of Jonathan Swift. Or Lenny Bruce. You can just hear it, can't you?

Judge: You say that fat people live longer after heart attacks? Impossible.
D.A.: I know, your honor. Fat kills! Most of the time.
Judge: What's your evidence, counsel?
D.A.: Everybody knows it's bad to be fat!
Defense: Objection! "Everybody knows" is not admissible in court.
Judge: Overruled. In this case, no evidence is necessary. [rises from seat, points accusing finger at defense counsel] You're not eligible to serve as counsel in this case, Counsel, because . . . you're FAT!

And so on.

The real obesity paradox, of course, is our culture's blind and stubborn insistence on vilifying and demonizing fat people and fat, in the face of any and all evidence to the contrary.

Fat kills. Except when it doesn't.

Deaths from coronary artery disease in the U.S. went down by half between 1980 and 2000, and researchers at the University of Liverpool attribute this to positive lifestyle changes and better treatments.

Now for the bad news: Those same researchers go on to say, on no cited evidence, that the number of deaths would have been reduced even further had it not been for the rise in obesity and diabetes.

How do they know this? Well, they don't, actually. One researcher is quoted as saying, "The increase in obesity and diabetes are a wakeup call. They reflect the increasing consumption of large helpings of junk food."

Hmmm. So deaths from heart disease have decreased during the same time that rate of obesity have increased, yet obesity is still to blame. That's what I call having it both ways.

An epidemiologist could look at the same information and come to the opposite conclusion: That obesity has a protective effect when it comes to death from heart disease.

Seems like more of the same fat-is-evil ranting to me, liberally laced with assumptions and a heaping helping of bias. Mmm, mmm.

Another reason to look beyond weight and BMI

The New York Times reports the results of a study showing that young women who weigh enough to menstruate may still be eating too little to be healthy. Researchers at Ohio University found that bone formation, which is critical in adolescence, may not be taking place even if women get regular periods.

This is relevant because doctors so often use menstruation as a marker of health among those recovering from anorexia. But it's clearly not the criterion to live or die by.

Here's the money quote, to my mind: “Regular menstrual cycles do not reliably indicate that they are eating enough for what they’re expending,” Dr. Loucks said. Read more about it here.

Sandy Szwarc does it again

This morning I read the following sentence in Sandy Szwarc's most recent post in her Junkfood Science blog:

"Far more young people are dying from anorexia than . . . from being fat."

Tears sprang to my eyes. That is exactly right.

The emphasis on "overweight children and teens" clouds the issue for the public and for health professionals. So long as doctors and the rest of us are so terrified of being fat, and of having our children be fat, lethal eating disorders like anorexia and bulimia will be underdiagnosed, mistreated, and poorly researched.

Thank you, Sandy, for putting it so plainly.

Repeat after me: Fat is good

An interesting study crossed my desk this week, from a team of researchers in New York who posed the question, "Does percent body fat predict outcome in anorexia nervosa?"

They looked at a number of factors they thought might contribute to relapse in anorexia recovery, including BMI, leptin levels, waist-to-hip ratio, the subtype of anorexia, and percentage of body fat. Only one--body fat--seemed to affect the rate of relapse. "In recently weight-restored women with anorexia nervosa," they wrote, "lower percent body fat was associated with poor long-term outcome."

We're so used to thinking of fat as the Ultimate Evil, which must be banished at any cost, that news like this can feel downright shocking. Fat can be not just good but essential. Without it our brains don't work very well. We're supposed to have a certain amount of fat in our bodies.

This is important for those in recovery from anorexia, especially people (like my own daughter) who are naturally athletic and build a lot of muscle mass. Nothing wrong with muscles, but you've gotta have fat, too. Lean muscle mass without body fat is associated with relapse. And that's not what anybody wants.

So repeat after me: Fat is necessary for human life. Fat is not evil. Fat can even (dare I say it?) be a Very Good Thing.

Advocacy for what?

I've given a lot of thought to how those of us who have children with eating disorders can model our advocacy efforts after those of other groups. Parents of kids with autism, for instance, have been very effective in pushing for legislation covering treatments and other issues.

The thing is, most people aren't busy arguing about what causes autism in the first place, and they pretty much agree on treatments. Whereas folks in the e.d. world are divided in every possible way.

My friend Laura Collins says she'd like to lock all the e.d. experts in a room until they come to an agreement. Ha!

One of the biggest arguments, of course, is the biology-vs.-psychology one. Both parents and professionals have vested interests in taking one side or the other when it comes to both cause and treatment.

When I imagine trying to bring together a coalition of eating disorders parents and professionals to push for legislation and advocacy, I get a sense of how great the conflicts are. For instance, I don't think individual therapy is useful in treating anorexia, at least not during the active recovery phase, so I'm not sure I would want to push for legislation to cover lots and lots of individual therapy.

In case you couldn't tell, I'm of the biology camp, as in the Minnesota Starvation Study. I don't believe kids "think" their way into eating disorders, and I'm damn sure they don't think their way out of them.

I think what's needed most are more and better treatment studies, like the one Dan Le Grange is doing at University of Chicago. We need to know what the best treatments are for anorexia and bulimia.

What do you think we should be pushing for?

How cliches hurt us

What do the obesity epidemic, anorexia nation, and healthy eating all have in common?

They're all cliches, code phrases created by the media. And by "the media" I mean not only the Gray Lady and the Sly Network but small local newspapers, big national magazines, and--oh, yeah--those of us who write and blog about these subjects.

Each of these code phrases contains layers and levels of meaning that never get unpacked. They're like cue balls careening around a pool table, knocking all the other balls out of their way.

When you read the words "the obesity epidemic," you are, in essence, being told what to think and how to think it when it comes to the issue of overweight in America. The phrase itself shapes the way you think about it. If the language were different--if the issue was framed in another way--you might think about it differently.

And this is where I hold the media, and all of us, accountable for the superficial and slick way these deeply important subjects are framed and discarded. Each time yo say the words "the obesity epidemic," you're validating the notion that the nation is in the grip of a contagious pandemic of overweight. If that's what you truly think, you're all set. (I'd like to argue the point. But that's another post.)

But chances are it's not really what you think or what you mean to say. But each time you use that code phrase, you're buying in to someone else's conception of the dialogue. You're letting yourself be co-opted.

It's hard to unpack these code phrases. It's even harder to go against the mainstream, to question the conventional wisdom, to challenge the status quo. But more and more, I think it's crucial that we do exactly that. So next time you find one of these cliches or code phrases flying out of your mouth or tripping off your fingers, take a minute, or five, to consider what you really think. Then say it in your own words.

I'll start: I think the idea of an obesity epidemic is a sadly unimaginative construct that has little or nothing to do with reality. It's a cover for institutionalized prejudice against overweight people, a trigger for eating disorders, and a big waste of our collective time and energy.

Your turn.

There's a sucker born every minute

As P.T. Barnum is often (mistakenly) quoted as saying, There's a sucker born every minute.* And right now, those suckers are us.

At least, those of us who are rushing out to buy the newest FDA-approved diet pill, Alli.

Let's start with the fact that Alli doesn't actually work. Or rather, it doesn't work quite the way you think it might. Taken before meals, it prevents your body from absorbing the fat in food. But it has another mechanism that isn't being touted quite as enthusiastically. Think Antabuse for fat. If you eat fatty food while you're on this stuff, you are likely to have explosive and uncontrolled bowel movements that "smell like fish oil," according to one website I read. This site cautioned consumers to carry a package of baby wipes and an extra pair of pants while taking Alli. Presumably you need experience this only once before you're frightened out of eating fat. Or out of taking the pill.

Don't bother to take Vitamin E while you're on this stuff, either. Alli is likely to decrease your body's ability to absorb fat-soluble vitamins--E, A, D, and K, along with beta carotene.

As Sandy Szwarc points out in her May 25th blog on the subject, this little pill is getting a great big push from its U.S. distributors, GlaxoSmithKline, playing up the FDA's approval (what in the world were they thinking?) and betting that consumers will pony up two bucks a day for the privilege of taking this pseudomedication. And talk about disingenuous! If this article from the New York Times doesn't make you want to scream, your b.s. detector's not working.

How stupid do they think we are? As stupid as we are, apparently. Thin at any price--even wearing adult diapers or buying a whole new wardrobe of all-black pants? I don't think so.

*(If you can tell me who actually said that quote--no fair using Google to find out--I'll send you a free Mr. Wrong T-shirt.)

Thin at any cost

The most horrifying news story I’ve read this spring wasn’t about terrorism or war but about a hormone called leptin, known for its role in regulating appetite and metabolism. Since its discovery in 1994, leptin has become the holy grail of anti-obesity crusaders, a miraculous substance that could suppress appetite at the source: in the brain. In this society, anything’s better than being fat.

Leptin’s superhero status was enhanced last year when a study in the American Journal of Physiology showed that infant rats who were fed lots of leptin never got fat or developed diabetes, no matter how much fat they ate. The idea, explained one of the study’s researchers, was to change the way the body uses and stores energy. In utero and/or early exposure to leptin apparently makes the body metabolically inefficient—not just for a little while but for good.

This finding made leptin the A-bomb of the War on Fat, at least according to a group of researchers at the University of Buckingham. They’re developing a line of baby foods and formula laced with leptin. The goal: to make children thin for life.

Before you start cheering, remember fen-phen, the miracle drug that was supposed to make people thin? It damaged their hearts, and has inspired thousands of lawsuits, many still ongoing 10 years later.

Remember thalidomide?

Even if leptin-laced formula does what it’s supposed to, even if there are no immediate negative side effects, it’s still a worrisome proposition. The nifty little feedback loop we call metabolism serves us well. Human beings are designed to get hungry and eat. It’s a matter of survival.

Witness what happens when the link between appetite and behavior weakens or breaks. My husband and I watched our 14-year-old daughter nearly starve to death after developing anorexia. For two long years, she never felt hungry. She was hungry, of course; many of the behaviors associated with the illness—obsession with cooking, cutting food into tiny bites, pouring mustard on everything—proclaimed this appetite, despite the fact that she herself didn’t feel hunger pangs. But the connection between her brain and her body had been disrupted by the illness.

For my daughter, recovery from anorexia meant gaining quite a bit of weight. What if she’d been a leptin baby, her metabolism engineered to make weight gain difficult or impossible? No matter how many calories a day we fed her, she might not have survived. Some researchers believe that breakdowns in leptin regulation and processing might be part of what causes anorexia in the first place. Certainly an important step in my daughter’s recovery has been learning to recognize feelings of hunger and fullness again—feelings she would never have access to, if the Birmingham researchers have their way.

As a recent UCLA study showed, 98 percent of diets fail, causing a rebound effect that winds up making people fatter. Ditto the no-fat craze of the 1980s, which may well have something to do with the current rise in obesity.

No matter how well-intentioned, our attempts to micro-manage our metabolisms usually cause more harm than good. Better to teach kids to eat when they’re hungry and stop when they’re full, and to accept the fact that humans come in different shapes and sizes, than to mess up the next generation’s neurochemistry in the name of thinness.

More inspiration from autism advocacy

A reader sent me this link for an inspiring story about success from a group of parents with autistic children and their advocacy work.

What's it gonna take for those of us with children who are eating disordered? What would it take to force insurers to cover e.d. treatments at the same level they cover other biologically based illnesses?

Maybe we each need to pledge to do SOMETHING on the advocacy front when we're able.

Taking a lesson from autism

An article in my local paper got me thinking yesterday. If the autism parents can get their shit together to push for more comprehensive insurance coverage of their kids' illness, why can't we?

Jim Lock himself, one of the gurus of the Maudsley method here in the U.S., once told me that eating disorders parents should model ourselves on the autism parents. As a group they've dedicated themselves to not just supporting their children but to advocacy on all levels--especially, now, with regard to insurance coverage.

The article quotes an autism professional as saying "Most of the major autism organizations, both providers and support groups, have come together in agreement that insurance coverage for all individuals with autism is a positive and important need."

Same goes for anorexia and bulimia, as well we know.

Like anorexia, autism is often not covered, or covered poorly, because it's classified as an emotional disorder rather than a brain disorder. But I say, if your brain isn't considered part of your biological body, then what is it--a disembodied organ floating in space?

One of the autism advocates is quoted as saying "We're continuing to work together in the hope legislators take notice that the need is not going to go away and we're not going to go away."

Hey, what about us? What about those of us who have watched our children waste away or go through hell, only to be told that insurance doesn't cover therapy, or IP treatment or whatever the doctors are recommending at that moment?

What about people like Anna Westin, whose smart, articulate parents fought like hell to get her well, only to be turned down by insurance eventually? Anna committed suicide, and her parents took her experiences to the state insurance commissioner and to the courts and won not just money but also changed the way insurers in Minnesota cover anorexia.

We could do this, state by state. That's what it's going to take, probably, unless we can get the federal mental health parity bill passed.

I'm sick of "steps forward," though, and "making progress." We aren't making progress when it comes eating disorders. What will it take?