One hospital that gets it

I'm deeply encouraged by a new study from the Children's Hospital at Westmead, in Sydney, Australia, where in 2002 clinicians set out to reduce the rate of readmissions and relapses they were seeing on the eating disorders ward. They began offering the Maudsley method for families with children and teens being discharged, and saw their readmission rates drop significantly.

They also identified four "practice challenges," aspects of treatment to pay attention, and I think three of them are worth repeating here because they get to the core of the challenges of family-based treatment.

1. Parallel process, or getting families and treatment providers on the same page. "Failure to achieve this tends to replicate the dynamic seen in a split parental team and leads to conflict, confusion and treatment failure," wrote the study's authors.

2. The therapeutic relationship with the family. "The therapists connection with the parents plays a significant role in helping them remain focused and energized for the task at hand. . . . The relationship for single parents with the therapist and supporting team is particularly significant, taking on an important role of emotional support that parallels the support that parents would give each other in an intact family."

3. Difficulty in predicting which families will succeed. "Clinicians need to maintain optimism and faith in a family's capacity, regardless of how they present."

Parents, if you're looking for treatment for your child, I hope you'll keep these important lessons in mind. Don't be afraid to bring them up with your treatment team.

5 Things You Should Never Say

We've talked about the kind of corporeal self-loathing that's become institutionalized in American culture, especially among women. We've promised to try to love our own bodies. (Right?) Now let's take all that a step further and think about the kinds of things we say to one another about the way we and other people look.

Here's my vote for 5 things you should never, ever say to anyone. No matter how thin or fat s/he is. No matter how much you really want to. Because not one of these comments is helpful, and some are harmful--to you if not to the other person involved.

1. You look great! While there's nothing wrong with a sincere compliment, this is typically not sincere. It's usually code, meaning either You look great, you've lost some weight! or You look great even though you're still fat! Try, instead, something specific, like I love your hair like that. Better yet, skip the comments on other people's appearance and find something more interesting to talk about.

2. I never eat X. Maybe you're a vegetarian who hasn't eaten meat in 20 years. Maybe you're allergic to chocolate. Or maybe you're caught up in the good food/bad food syndrome, where the demon du jour is carbs or fat or whatever. My advice: Keep your food tics to yourself. Better yet, get over them. Learn to love your body and respect the fuel that keeps it going.

3. I guess you got the thin genes! This comment was actually directed to my daughter by a salesperson. I was the one shopping; I'd just come out of the dressing room with an outfit on. My daughter had recently been diagnosed with anorexia and was emaciated and awful looking; she was with me that day because she was too anxious to be home alone. This salesperson managed to insult both of us with one comment. I haven't shopped in that store (which used to be one of my favorites) since.

4. Aren't you worried about your health? Translation: You should damn well be worried about your health, you fatso. Given what we know about the tenuous to nonexistent relationship between weight and health (see Sandy Szwarc's righteous columns, Paul Campos' writings, Gina Kolata's book, and other up-to-date treatments of this subject), this comment is outdated and ineffective. And just plain cruel.

5. I wish I had a little anorexia! Do I need to tell you why this is a stupid, cruel thing to say? I don't think so. You realized that the minute it came out of your mouth.

Now that you've developed your inner editor, here's one thing you can always say: I love you. Repeat as needed.

National Love Your Body Day

In honor of National Love Your Body Day, I want to remind my readers to take the "I Love My Body" pledge.

Then check out the Love Your Body show.

Then do something fun for your body today--take a walk, eat some chocolate, go dancing,sunbathe (well, not if you live in Wisconsin). Be kind to your body and yourself. Doctor Harriet's orders.

Attention chocoholics

According to this study, there are two kinds of people in the world (metabolically speaking): chocolate lovers and those who are (can it be?) indifferent to chocolate's virtues.

The idea behind the study, frankly, smacks a bit of Big Brother:

This study by Swiss and British scientists breaks new ground in a rapidly emerging field that may eventually classify individuals on the basis of their metabolic type, or metabotype, which can ultimately be used to design healthier diets that are customized to an individual's needs.

I'm not sure I want to go there, or anywhere where someone is going to design a "healthier" diet just for me. Been there, done that (Weight Watchers, 1974).

Still, if it included chocolate, maybe it wouldn't be so bad. . . .

Bet you won't see any mainstream news stories about this

And by "this" I'm referring to the results of the biggest clinical trial of healthy eating ever, as reported by Sandy Szwarc over at Junkfood Science. We're talking about part one of the Women's Health Initiative Dietary Modification Trial, which posted results like these:

• Healthy eating had no effects on rates of cardiovascular disease.
• Healthy eating had no effects on rates of breast or colorectal cancers.
• Women who followed a "healthy (lower-fat) diet did not wind up thinner.
• Women who didn't "watch what they ate" and ate more fat and calories didn't wind up fatter.

Did you read any news stories about this? Me neither.

Results from Part II are about to come out. I can't wait to not read those, too.

Stick it to Ed (musically)

One of the great pleasures of the NEDA conference for me was meeting Jenni Schaefer, author of the book Life Without Ed. Jenni is a courageous and articulate advocate for all those who have struggled with eating disorders.

And she also happens to be a pretty rockin' songwriter, too! Her new single CD is called, what else, "Life Without Ed," and it's inspiring listening. Have a listen here. It's very cool.

Do your Monday morning best for mental health parity

This just in from the Eating Disorders Coalition:

"Thank you for all your unified effort in supporting the passage of mental health parity! We are close to victory in the House of Representatives— to pass H.R. 1424, the “Paul Wellstone Mental Health and Addiction Equity Act”. This bill would require health plans to cover eating disorders and has made it out of 2 committees and the subcommittee of Energy and Commerce. The last step in order for the bill to go to the floor for a vote is to get moved out of the Energy & Commerce Full Committee. That mark-up is scheduled for next Tuesday, October 16th. We need your action on this!

If your Representative is a member of that Committee, please call him/her on Monday morning to urge a “YES” vote on the bill, and a “NO” vote on all weakening amendments!"


And here's the list of representatives on that crucial committee. If yours is on there, please give him or her a call. The EDC has even written a suggested script for you to say when you do call: "“I’m calling to ask the Congressman/woman to VOTE FOR H.R. 1424 on Tuesday in the Energy & Commerce Committee, and to VOTE AGAINST all amendments to substitute weaker language. Americans deserve the same mental health parity protections that members of Congress enjoy, for all mental and addictive disorders, not just the ones health plans choose to cover.”

Go forth and help make policy. And parity.



FULL COMMITTEE

John D. Dingell (MI), Chairman

Ratio: 31-26
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

See a video on Maudsley

Here at NBC Chicago. Try not to pay attention to the misleading title, and you will have to watch a short ad before the video loads, and of course there are the usual caveats at the end of the piece. But it seems like a good look at an ordinary family who are helping their daughter through family-based treatment Features Dan Le Grange. I think it's worth a watch.

I just don't get it

It is just shocking to me that so many people misperceive and fear family-based treatment.

I'm no dummy: I know even FBT is no panacea. It won't cure everyone. But it cures a damn sight more folks than anything else we've got. And a lot quicker, too.

So what's the problem? We don't advise against penicillin because some people are allergic to it, do we? We don't dismiss Prozac because hey, it doesn't work for everyone.

So why are people so dismissive of Maudsley? I'm talking about people who haven't worked with it, who are going only by what others say about it.

Maybe it's like a generic medication--there's no big money to be made on it, so there's no incentive to fall in love with it.

But as Daniel Le Grange said to me recently, "We're not doing very well by our children." FBT helps children and adolescents, no question about it. The statistics are very good--80 to 90 percent of those treated with it are still recovered after five years.

FBT doesn't get into cause. It doesn't have an opinion, so to speak, on psychodynamic issues. It rather neatly sidesteps them, at least for phase 1 of treatment--weight restoration.

Is there anyone out there who can truly argue with the need for someone who is severely malnourished to gain weight?

I just don't get it.

6 lessons I learned at NEDA

1. There are lots and lots of well-meaning but ineffectual folks working in the eating disorders field.
2. There is lots and lots of Big Money at stake in the eating disorders field, mostly in the form of residential treatment centers.
3. There are lots and lots of politics in the eating disorders field.
4. Family-based treatment, which the scientific literature recognizes right now as the only evidence-based treatment with an 80 to 90 percent long-term success rate in adolescents, is perceived as controversial in the eating disorders field, even by some of those who profess to support and use it.
5. The most commonly heard comment about FBT at the conference: "Don't you have to be a very special family to make it work?"
6. The intensive outpatient family therapy for eating disorders program at University of California-San Diego, headed by Dr. Walter Kaye, looks absolutely wonderful.

I'm sure there are more, and I'm sure I'll be posting about them too.

Sunday morning at NEDA

The NEDA conference is officially over, but I've still got a bag full of brochures and other stuff I collected here (and I'm not going home until tomorrow morning), so I thought I'd offer another deconstruction of e.d. programs and what they offer to parents.

The reason I'm doing this, by the way, is not just to make enemies (though I'm sure I am) but to try to offer one parent's view of what's on offer. I think it's especially important given a snippet of conversation I had yesterday with one of the long-time NEDA folks, whose comment about Maudsley was, "But you have to be a very, very special family to make that work, don't you?" This is, of course, the mainstream view, and of course it's completely erroneous. It's part of the disempowerment of parents within the eating disorders field that just burns my boat.

So. Within that context, it's not surprising to find brochures like the one I picked up from the Women's Center at Pine Grove, in Hattiesburg, Mississippi, a treatment facility that treats e.d.s, addictions, and both. Here are some of the phrases that jumped out at me from this 12-page glossy brochure: "Components of the treatment experience include understanding the disease process and the camouflaged self, helping women reclaim and celebrate their feminine spirit, empowering women to come to their own assistance. . . . " There's a family week--sounds good, right?--described as "40 hours of intensive therapy where the healing process between family members begins." OK, this center is for women strugglng with addiction as well as e.d.s, and does not seem geared toward adolescents. There are photos of lovely flower arrangements and wooden staircases. Under Amenities, the brochure says, "We offer gender-responsive treatment in a quiet, peaceful, and secluded environment." I'm not sure what gender-responsive treatment means. The next paragraph goes on: "We encourage our patients to take advantage of the nearby YMCA . . . a facility that includes weights, cardiovascular equipment, indoor track and pool, indoor racquetball and basketball course."

Hello? For women in the throes of anorexia?

Nowhere in this brochure is there any mention of food or eating. Nowhere. There is one line under "Components of Treatment" that says "Nutritional counseling." It's about halfway down a list that includes items like "Boundaries & Relationships," "Exercise & Fitness," and "Psychodrama."

I don't think so.

Saturday morning at NEDA

This morning's program featured two parents and a husband, all of whom had family members who had anorexia, all of whom had the same therapist. I have tremendous respect for all three of these people, who obviously went through tremendous suffering. I'm happy to say that all three of their family members recovered and are now doing well--but only after many years of being ill. One spouse was ill for 10 years; one of the children was sick for 6 or 7 years, and the other for 10 years.

One of the parents made a comment that for me crystallized everything that's wrong with the way eating disorders have been traditionally treated. He said, speaking of his then-11-year-old daughter, "My wife and I quickly had to accept the fact that this thing was bigger than we were, bigger than our family. There was no way we could help her. We had to turn to the professionals."

His child's recovery followed a fairly typical trajectory: years of very slow progress and relapse, until, as he put it, "She *decided to join us in the fight against her illness."

I got tears in my eyes at that moment, tears of rage for the clinicians who disempowered this family and made them believe there was *no way* they could help their daughter, who taught them that their daughter had to "choose" to get well. For all the families who have accepted that over the years, who have sat at dinner tables watching their children starve and felt there was nothing they could do. Who, frankly, wasted years of their own and their child's life in useless and even counterproductive treatment.

I am so grateful for family-based treatment, for having my role as a parent validated and for being able to help my daughter. Another of the parents said, "I wanted to just march in there and get this thing fixed! But we had to embrace the illness and accept that it would be with us for a long, long time."

If only she'd been told about FBT, how might her life and the life of her daughter have been different?

If only they knew . . .

Over the last two days I've collected quite a bit of material from the many residential treatment centers that are exhibiting here at NEDA. I'm going to be writing about a few of them, starting with the brochure from Rogers Memorial Hospital in Oconomowoc.

If only the people who'd put this slick piece of marketing together knew how parents really reacted to it--or should. I already have an opinion about the programs at Rogers, but if I didn't, this would certainly sway me.

For starters, the image on the cover is of a girl. A young woman, really, maybe 14 or 15 years old. She's smiling, she's very pretty--and she's excruciatingly thin. It's hard to tell just how thin because she's wearing a hoodie over a shirt. But she's a lot thinner than I'd want any child of mine to be. Is she supposed to be recovered? In recovery? Newly arrived at Rogers? If this is a picture of the Rogers recovery, I'd run in the opposite direction. Fast.

Then there are the words that go with this image: "At Rogers Memorial, we utilize proven, evidence-based treatment components that give individuals with an eating disorder the best chance at recovery."

So far, so good. But there's more: "Our philosophy encourages self-empowerment, so that the individual's recoveryt is a result of his or her own success."

Uh-oh. If I'm a new parent I might think this sounds good. But everyone else will read this and know what it refers to: the tired, disproven notion that the individual must "choose" recovery.

Next come some quotes, presumably from Rogers patients, though they're not identified. Top of the list: "The treatment and therapies helped me realize it was my choice to get better." I say stop reading right there and throw the darn thing away. But if you insist on continuing, you'll find this one: "The art therapy was extremely helpful and provided another way for me to explore my eating disorder."

Explore your eating disorder? Honey, I don't want you to explore your eating disorder. I want you to RECOVER from it. Big difference. In fact we may be talking an oxymoron here.

Seen enough? No? Then turn the page for more on the Rogers approach: "Our treatment approach encourages self-empowerment. From admission to discharge and aftercare planning, individuals are involved in every step of the treatment process."

As the parent of a child who's recovered from an e.d., I can't think of anything worse than to have my child involved at every step of the way. As those of us who have been through this know, a child is INCAPABLE of "choosing" recovery, and when she's very very ill, such insistence will a) prolong the course of the disease, b) make treatment ineffective, c) exacerbate the child's already sky-high anxiety, and d) make veryone involved feel guilty as hell for not being able to "choose" recovery.

And here's the thing that gets me: This brochure is supposed to be marketing the program, making it sound irresistible to parents.

I'd say the Rogers folks haven't got a clue about what at least some parents want. And judging from this brochure, I'd say my confidence in their ability to help my child recover is pretty minimal.

That's it for tonight. I'll pick apart some more tomorrow.

More from NEDA

One of the heartening things about the conference so far has been that the amount and kind of discussion around family-based (Maudsley) treatment for anorexia and bulimia. There's been a lot! And all of it's been positive, at least that I've heard. In fact I would say that Maudsley has become something of a buzzword. Some of the people using it seem to have only a hazy idea of what it means, but I guess that's part of the process of this kind of social change.

The general session speakers have been a real mixed bag. This morning's speaker spent more time telling anecdotes about her cats, her children, and herself than anything else, and when she did finally get down to brass tacks, she mostly talked about body image. I'm all for discussions of body image, and how to improve it, but what got to me was her automatic assumptions that disturbances of body image = eating disorders. There was a lot of talk about things like guided visualizations, talking "to" problem body parts, and so on, none of which interests me but hey, I can see that it might be of interest to some people.

The thing that got me, though, was when she tried to connect these kinds of problems and solutions to anorexia. I asked her, if body image disturbance causes e.d.s, why don't we have way more prevalence of anorexia and bulimia? She had no answer. Later, someone else suggested to me that while AN and BN are relatively low incidence, there are a lot of eating disorder not specified cases that don't show up in the statistics. Maybe. What bugs me is the thought of people with anorexia and bulimia who are valiantly trying to recover through these kinds of treatment techniques. There is no evidence to suggest that they're effective. Common sense, and having gone through anorexia with my daughter, tells me they can be worse than useless--they can destructive because they take focus off the things that really matter, like refeeding. So I'm not thrilled with what I heard there.

This afternoon's speaker, Michael Strober, did a very good job of discussion some of the neurobiology of comorbidities. He made one interesting point (well, he made more, but this one was of most interest to me): he said that while most depression that you see in patients with anorexia comes as a result of the starvation, and shows up after and as a byproduct of malnutrition, the heightened anxiety you see almost always precedes the dieting and weight loss behaviors. This was certainly the case in our family: my first inkling that anything was wrong with my daughter was her anxiety level skyrocketed, and she'd never been an anxious kid. No one understands the mechanism, but it was a very interesting observation.

That's it for now--gotta go get in the hot tub! (LOL)

More from San Diego later.

San Diego dispatch

Here I am in beautiful San Diego at the NEDA conference. It's my first time at something like this and I'm not sure what to expect. So far . . . well, it's a mixed bag.

Yesterday afternoon I was lucky enough to have lunch on the UC-San Diego campus with Dr. Walter Kaye and his talented team. Their 5-day Intensive family outpatient program for treating anorexia and bulimia sounds fab to me. (Check it out at http://eatingdisorders.ucsd.edu/IFT.html.) If the program had been around when my daughter was diagnosed with anorexia, I think we would have been here in a heartbeat. And I think it would have been a life saver. Literally.

Back at NEDA, pretty much the first thing I did was wander the hall of goodies, where the folks who treat e.d.s set up booths and put out their marketing info. It was all very slick and very disheartening. I walked around asking people what their treatment philosophy was. Half of them didn't understand the question. Many reassured me that they had "all kinds of treatments." Horses seemed to figure prominently, at least in the literature, along with "groups getting at the psychosocial dynamics of anorexia" and so on. When I asked what kind of evidence-based treatments they offered, most looked blank. When I asked how or whether they included families in treatment, a few sounded intelligent, but most, once more, looked blank.

Then again, we're dealing with an area where the American Psychological Association itself still lists
"dysfunctional families or relationships" as one cause of anorexia, and describes the anorexics as "refusing to eat." Tsk tsk, APA; you're sadly out of date. If you knew one thing about anorexia you would know that it's not a refusal to eat; it's an inability to. And you'd also know that PARENTS DO NOT CAUSE EATING DISORDERS. (Read the APA's ill-informed e.d. page at http://www.apahelpcenter.org/articles/article.php?id=9.)

The worst of the hall were the booths sponsoed by the big guns in e.d. treatment: Renfrew, Rader, Remuda. There were lots of slick little products to take home, ranging from staplers to, I kid you not, Zen sand gardens. What does all this have to do with treatment? You have to be cynical here and remember that there's very big money attached to the treatment of e.d.s. I would have far preferred an outcome study for parents to take away over a cutesy little mirror with an affirmation on the back. Please.

The keynote speech last night started out well, with a report from Lynn Grefe, the president of NEDA. Next up was a young editor from CosmoGirl whose main purpose seemed to be to convince us of how well-meaning that magazine is about presenting positive body images to young women. It sounded like one big advertisement for CosmoGirl. Somewhere in there she referred earnestly to an article they'd run called "Fat and Thin," and flashed a visual from the magazine on the screen. There it was: a headless fattie, next to a headless waif, followed by more earnest talk about how obesity is an eating disorder, too.

I wanted to stand up and say, "That's like saying thinness is an eating disorder, honey. It's not how much you weigh; it's your relationship with food and eating." But it is, after all, my first NEDA conference, and I was feeling a little shy.

Next time.

More from NEDA later today.

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.