Join the fray . . .

over at BusinessWeek, where there's a somewhat spurious debate going on over whether the media causes eating disorders. Normally I try to stay away from arguments like this, but because it's BusinessWeek, a fairly respectable publication, I think it's worth it to put the point across. Be warned: There are some real trolls commenting over there, so don't visit if you're feeling fragile.

We're getting there. . . .

And I know this from reading pieces like this in the New York Times. Turns out your performance on a treadmill test is a far better measure of your mortality risks than the numbers on a scale. We told you so!

So yes, it's better to be fat and fit than skinny and unfit. And yes, let's take a look at just how loaded words like fat and overweight are in our culture.

I can't wait for this kind of thinking to percolate down through the culture. Just last night I was at dinner with, among others, a woman who teaches others about exercise and fitness. She paid lip service to some of the "fat but fit" thinking, but her parting comment was so typical of this debate: "But it's still bad to be fat."

I'm sending her the link to this article. Hope she gets it.

Book review: Why She Feels Fat

If you pick up Why She Feels Fat, by Johanna Marie McShane and Tony Paulson, because you want to understand the inner life of someone with anorexia, bulimia, or binge eating disorder, you'll be sadly disappointed. Actually I think you'll be disappointed no matter why you pick it up. There are dozens of books exactly like this already in print. The world certainly doesn’t need another one.

I expected to read an insightful exploration into the biology and psychology of eating disorders. I expected to find an answer to the question posed by the title. Why do people with anorexia and bulimia feel fat even when they’re not? The phenomenon has been well documented; Walt Kaye tells the story of bringing two 70-pound anorexic women into a class of med students and asking them to describe each other. Each sees the other as way too thin, gaunt and unattractive. Each sees herself as way too fat. This is a fascinating demonstration of distorted brain chemistry at work.

But these aren’t the kinds of questions the authors take on. Their answers to the question posed in the title are the same old same old we’ve been hearing for many years now about eating disorders: She feels fat because she was sexually abused, because her parents divorced, because her mother is overly critical and her father is absent. She starves, binges, and/or purges because—wait for this groundbreaking revelation—it’s a way to control a disappointing or painful world.

There's nothing about biology, genetics, or any of the new research on eating disorders that is changing the way we understand and treat them.

There's nothing new about the so-called insights offered by this book: They're all the rationalizations and delusions of eating disorders, offered up without analysis or true understanding. When my daughter was ill with anorexia, I heard them all. The difference is that I didn't take them at face value. These authors appear to do just that.

The section on treatment is just as outdated and even harmful. "The job of the therapist is to help your loved one understand, acknowledge, and resolve the issues that are fueling her illness," write the authors. In the meantime, if your loved one starves to death, or has a heart attack, well, never mind. At least they'll get to the bottom of the problem.

The job of the therapist is not to answer the question why. It's to heal the eating disorder.

If the authors were up on the latest research on treating eating disorders, they wouldn't write, as they do, "Medication may be necessary either for the short term to facilitate treatment or for the long run to achieve emotional balance." While there are n o doubt people for whom medication is helpful, none of the big studies have shown any reason for routinely prescribing meds like Prozac and Paxil for those with eating disorders. This is not only wrong-headed advice--it's one size fits all advice.

The authors also recommend working with a dietitian or nutritionist--again, standard advice for someone with an e.d. They continue down the conventional path by recommending that the nutritionist and patient develop an eating plan together. This might be good advice for treating bulimia, but it's definitely not good advice for treating anorexia. And that's another of the problems with this book: The authors don't differentiate among the eating disorders.

I could go on, but you get the idea. No stars for this book.

Eating disorders workshops in central New York

The Mental Health Association of Onondaga County is offering a two-part Parent Partner Workshop, held on September 9 and 16th in Syracuse, NY. These three-hour workshops are designed to help families and loved ones support people with eating disorders, and I hope if you're in central NY you'll try to make one of the workshops. I'm thrilled that I've been asked to speak on the 16th. If you attend, please come say hello. I'll be talking about our family's experience with anorexia and about Maudsley Parents.

And the best part is that snacks are provided!

Details:
Sept. 9 & 16
6-9 p.m.
Cornell Cooperative Extension, 220 Herald Place, 2nd Floor, Syracuse
$10.00 per person, $30.00 for family of 4

Follow-up on A.

I emailed A. and heard back from her--a great email. She knows exactly what she's dealing with, with our family, and seems to have a pretty good handle on it.

And it seems that we can develop a relationship. I'm very glad.

Eating disorder studies

Hello all,

Here's your periodic roundup of research opportunities available in the e.d. world. We all know there is woefully little research on e.d.s--here's your chance to help make a difference. And maybe get some top-of-the-line free treatment.

Research Studies on Eating Disorders:

Clinics and Hospitals Team up to Study Eating Disorders: Six North American sites are teaming up to evaluate outpatient treatments for adolescents with anorexia nervosa. To date, this is the largest National Institute of Mental Health-funded anorexia nervosa treatment study. The study will allow for a thorough evaluation of two types of family therapy and will also test whether FDA approved antidepressant medication can enhance and prolong the result. The goal of the study is to improve recovery rates.

"Males and females ages 12 through 18 are the target population, because it is essential to identify and treat the illness in its early stage," says Craig Johnson, Ph.D., director and founder of Laureate Eating Disorders Program. He says that a parent may suspect anorexia nervosa if they have an underweight child that worries about their weight and appears to avoid food obsessively. Dr. Johnson and Ovidio Bermudez, M.D., internationally known eating disorder experts, are the principal investigators at Laureate for this study of two forms of outpatient family therapy. The treatments prescribed in the study, have been tested and shown to be helpful with patients in previous studies at Stanford University School of Medicine and The University of Chicago Hospitals.

After undergoing a screening process, families who qualify will be randomly assigned to one of four treatment combinations. The study is comprised of 16 one-hour family therapy sessions delivered over a nine-month time period and a medication (either fluoxetine or placebo) delivered over 15 months under close medical supervision. The family therapy sessions, medications and medication monitoring are all paid for by the NIMH grant.

This international eating disorders study is being coordinated by Stanford University, and includes six recruitment sites: University of California San Diego, Washington University School of Medicine in Saint Louis, Cornell Medical College, Toronto General Hospital, Sheppard Pratt Health System in Baltimore and Laureate Psychiatric Clinic and Hospital.

Individuals who suspect they might have anorexia nervosa, family members who believe their child may have the illness and physicians of potential patients are urged to call Nancy Morales, RN at 918-491-3722 to learn more about the study and/or apply for participation.



San Diego, CA: UCSD Researchers Seek Males and Females with Anorexia Nervosa: The UCSD researchers are currently seeking adolescents and adults currently suffering from Anorexia Nervosa to participate in one of their three current studies. To qualify for any of the studies one must be at least 15% below ideal body weight and be fearful of weight gain, despite being underweight. Both adults and adolescents between the ages of 14-45 are needed to participate in a taste study and would be compensated for up to $70 for completing the assessments, taste tests and interview. Adults 18 years of age and older are needed to participate in a randomized control trial of the medication Quetiapine, in which they will receive either the study medication or a placebo. Subjects will be compensated up to $360 for completing study related assessments and the medication treatment. In addition, they are offering several months of family therapy treatment for families with adolescents between the ages of 12 and 18 at no cost. The adolescents in this study will also be randomly assigned to receive either the medication Fluoxetine or a placebo. For more information, contact UCSD Eating Disorder Treatment and Research Program at 858-366-2525 or email edresearch@ucsd.edu.



San Diego, CA: UCSD Researchers Seek Women Recovered From an Eating Disorder: Help UCSD researchers understand what causes eating disorders. They are seeking female participants between 18 and 45 years of age who are recovered from Anorexia or Bulimia Nervosa. By participating in the study, subjects will be assisting physicians and researchers in developing new treatments for these complex and serious disorders. Subjects will be compensated for your participation in this study. For more information contact the UCSD Eating Disorder Research and Treatment Program at 858-366-2525 or email edresearch@ucsd.edu.



Massachusetts Research Study - Massachusetts General Hospital Study of Therapy for Bone Loss in Anorexia Nervosa: The Neuroendocrine Unit of Massachusetts General Hospital is conducting research studies on anorexia-induced bone loss. Their screening study is for men and women age 12-50 with anorexia nervosa. They are investigating causes of osteopenia (or bone loss) in the spine, hip, wrist and total body. The study involves one visit of approximately 3 hours. Their treatment study is for women aged 18-45 with anorexia nervosa and absent or irregular menstrual periods. They are investigating the combined use of a natural hormone and a medication that is effective for bone loss in postmenopausal women as a novel treatment for the bone loss seen in women with anorexia nervosa. They hope that the combination of these two investigational medications will help rebuild depleted bone and prevent further bone breakdown in women with anorexia nervosa. The study consists of 6 visits over 12 months. A stipend of up to $675 is awarded throughout the course of the study. If interested, call Erinne Meenaghan, N.P. at 617-724-7393 or email nedresearchstudies@partners.org.



Massachusetts: Bulimia Nervosa Study: Free confidential treatment is available to those who are eligible. Do you or someone you know binge eat? Do you or someone you know compensate by vomiting or other extremes? Do you or someone you know have severe moodiness or relationship problems? Researchers are now enrolling participants (ages 18-65) in a free treatment study investigating two active treatments, including education and counseling, for bulimia nervosa. If interested call 617-353-9610 or visit here.



New York, NY: NIMH-funded, IRB-Approved Study of Adolescents with Bulimia Nervosa (ages 12 - 21 years). This study takes place at NYSPI/Columbia University and compensation is provided for participation ($100). For more information, contact Laura Berner at 212-543-5316. P.I.: Rachel Marsh, Ph.D., Assistant Professor of Clinical Psychology, Columbia University/ New York State Psychiatric Institute, phone 212-543-5384, email marshr@childpsych.columbia.edu.



New York, NY: The National Institute of Mental Health is sponsoring a multi-center international study to compare two types of family therapy as well as fluoxetine or placebo (an inactive medication) in the treatment of adolescents with anorexia nervosa. They are looking for families with an adolescent with anorexia nervosa between the ages of 12-18 years. Participation involves completing assessment interviews, questionnaires, and engaging in 16 family therapy sessions over the course of nine months with medication continuing for another six months. The study is being held at the Eating Disorders Research Program, The Westchester Division of New York-Presbyterian Hospital, Weill Medical College of Cornell University. Contact the Research Coordinator, Samantha Berthod, MA at 914-997-4395.



Pittsburgh PA. Seeking Women Recovered from Anorexia or Bulimia Nervosa. Dr. Walter Kaye and his research team at the Eating Disorders Research Program at the University Pittsburgh Medical Center are looking for women who have recovered from anorexia or bulimia nervosa for a research study on brain chemistry in eating disorders. Study participants must be between 18 and 45 years old, medication free (birth control pills acceptable) and not pregnant or nursing. The study involves phone interviews, questionnaires, PET and MRI scans, lab work, physical exam, two visits to Pittsburgh and 8 weeks of fluoxetine (generic form of Prozac). (Note: All expenses incurred during the study, e.g. travel expenses, lab work, physical exam and etc. are paid for by the study.) In addition, eligible participants will be compensated up to $1300 upon completion of the study. For more information, email EDResearch@upmc.edu or Dr. Kathy Plotnicov at plotnicovkh@upmc.edu or Dr. Sharon Barnes at barnessd@upmc.edu. Interested parties can also call toll-free at 1-866-265-9289 or submit a contact form online here.

"She's as big as a house!"

I spent last weekend at a reunion of my extended family. I've spent very little time with my family over the last 20 years. Many of my aunts, uncles, and cousins still live in the same little square of suburban south Jersey where I grew up. I moved away at 16 and never lived in the vicinity again.

And since my grandparents died--my grandmother 18 years ago, my grandfather 5 years ago--I haven't seen the extended family very often. We get together at funerals and weddings, and that's about it. Last weekend my aunt and a cousin planned a reunion of the very large extended family, so it was the first time in a while I saw many of the relatives I grew up with.

For the most part the weekend was wonderful--except for the fat talk. I knew there would be fat talk; there always is, with my family, most of whom are not fat, all of whom are very conscious about fat.

Among other things we created an epidemiological chart showing diseases in the family. Everyone was encouraged to list those that affected them. I wrote "eating disorders" and "anxiety" on the chart. My cousin L. happened to be standing nearby when I'd finished. L. has been fat for much of her life--anywhere from 20 to 120 pounds overweight. She's extremely judgmental about weight (most of all of her own, of course) and brings up the subject often.

L. has two daughters, both grown now. One of her daughters had bulimia as a teenager, or so I thought. I've always liked my cousin A. a lot, and was sorry she wasn't at the reunion. I turned to cousin L and asked, "A. had bulimia, right? How's she doing now?" (Cousin L. knows about my daughter Kitty's anorexia.)

Cousin L. (angrily): She said she had bulimia, but I never saw any evidence of it, and I'm a clean freak. I think I would have seen it.

Me: Why would she say she had it if she didn't? And didn't she end up in the hospital with a burned esophagus at one point?

Cousin L.: Well, all I can tell you is that she's big as a house right now. Big as a house.

Me: (just looking at her, saying nothing)

Cousin L.: It's a shanda the way she's let herself go. I've lost a lot of weight recently, and so has J. (her other daughter). Doesn't she look great?

Me: I wish A. had come to the reunion. I'd like to see her.

Cousin L.: (walking away) Big as a house. It's terrible.

This conversation pretty much embodies my family's attitudes toward eating disorders and weight--and, I daresay, the attitudes of many. Eating disorder, shmeating disorder, right? We don't take that stuff seriously. It's all a put-on, a game, a manipulation. But fat--now that we take seriously. Being fat is a crime. You shouldn't leave your house if you're too fat. You wouldn't want anyone else to see you.

And that's why I live a thousand miles away from my extended family. And always will.

OT: Bat mitzvah follow-up

I couldn't resist linking to this delightful blog, written and illustrated by a woman who attended my younger daughter's bat mitzvah a few weeks ago as a visitor to our community.

It's an unexpected perspective on not only my daughter's bat mitzvah but on being Jewish in America. And it's so much fun to read and look at. Enjoy!

Accused of anorexia

This morning I read yet another news story that described yet another celebrity "accused" of anorexia. That's the word the news story used: accused.

And it made me wonder. It's not the first time I've read this and it won't be the last. We accuse people of crimes, of transgressions, of doing wrong. Is having anorexia a crime?

I think the word choice speaks worlds about how we see eating disorders: as choices made to get attention, to punish others, to--fill in the blanks. For all our talk about eating disorders as diseases, we still--and by we I mean the culture at large--see them as manipulative choices people make.

When I read a story like this, I wonder what those who make such "accusations" are thinking. Is it something like "Aha, I caught you!" Do they feel superior to celebrities who might be ill with eating disorders?

The same magazines and newspapers that trumpet such accusations, of course, also report obsessively on every pound that celebrities, especially women, gain and lose. They write headlines about women who lose their baby fat 2 weeks after giving birth--as if this was not only a natural but a desirable state of affairs.

So the message is what? Be very thin, but not too thin? Where is the invisible line separating good-thin from bad-thin? If being thin is such a necessary condition, why is being too thin a crime?

Food for thought on a how summer's day.

Roundup of interesting medical news

I don't have much time for writing original posts right now, but here are a couple of recent studies that seem interesting for one reason or another to me. Discuss.


Farm-raised tilapia fish contains potentially dangerous fatty acid combination: Farm-raised tilapia, one of the most highly consumed fish in America, has very low levels of beneficial omega-3 fatty acids and, perhaps worse, very high levels of omega-6 fatty acids, according to new research from Wake Forest University School of Medicine.

A suspect found for SIDS
: New evidence is suggesting that a chemical imbalance in the brain may be the cause of some cot deaths.

Statins have unexpected effect on pool of powerful brain cells: Cholesterol-lowering drugs known as statins have a profound effect (and not necessarily a good one) on an elite group of cells important to brain health as we age, scientists at the University of Rochester Medical Center have found. The new findings shed light on a long-debated potential role for statins in the area of dementia.

Brain food - what we eat affects our intelligence: New research findings published online in The FASEB Journal provide more evidence that if we get smart about what we eat, our intelligence can improve. According to MIT scientists, dietary nutrients found in a wide range of foods from infant formula to eggs increase brain synapses and improve cognitive abilities.

Mazel tov Lulu!

Today is Lulu's bat mitzvah. Mazel tov, my dear daughter!

Make the call for mental health parity

According to the Eating Disorders Coalition, a lobbying group that Maudsley Parents is affiliated with, July 9th is National Call-in Day for mental health parity.

Says the EDC:

The US House of Representatives and the Senate negotiators have reached a final agreement on all the remaining mental health and addiction parity issues. However, approximately $4 billion over 10 years in offsets is needed to pay for the bill and must be found before parity can be brought to the floor in both chambers for final passage. Once an offset has been found, there is commitment from leadership in the House and the Senate to bring the bill up for a vote as quickly as possible.

Although House and Senate leaders have not decided yet where they will find almost $4 billion over 10 years to pay for the cost offsets required by Congressional rules, negotiations have successfully concluded on the key policy provisions. This compromise is the result of long negotiations and advocacy of organizations all across the country. The compromise includes many key provisions that were included in the House-passed bill, the Paul Wellstone Mental Health and Addiction Equity Act and would be an important step in ending insurance discrimination facing people with addiction and mental illness. Here are some key points in the compromise:
- The compromise requires parity in insurance coverage for addiction and mental health treatment for both in-network and out-of-network coverage. This does not mean that the bill requires that insurers cover addiction and mental services, only that if they do cover these services, there must be parity with medical/surgical benefits. This of course would be a very positive development both in requiring fairness in insurance coverage and taking a strong stand against discrimination toward people in recovery or still suffering from addiction and mental illness.

- The compromise requires plans to disclose their medical necessity criteria and reasons for any denials of coverage. This would be a major breakthrough, as many plans refuse to disclose medical necessity criteria or reasons for denial, especially when addiction treatment is sought.

- On the issue of protection of state laws, the compromise bill language is silent. The House bill explicitly protected state laws, and in earlier versions the Senate bill explicitly preempted state laws. Silence is a victory for those of us who agree with the House approach that state laws should be protected, since in most situations Congress must take explicit action to overrule a state law in order for state laws to be preempted. However, to make protection of state laws even more ironclad, we will be working to ensure that the legislative history of the bill makes clear that the sponsors’ intention is to protect all state laws. That way, as important as the passage of a federal parity law would be, stronger state laws would remain in effect and states would be free to enact additional stronger protections in the years to come.

Wednesday July 9th is National Call-in Day so please call your Member of Congress and Senators on July 9th and tell them that now that an agreement has been reached between the House and the Senate, Congress must find the money to fund this historic mental health and addiction parity legislation and pass parity now.

For more information, visit our National Call-in Day Online Advocacy Action Center.On the website you will see background information, a script for the call and a tool you can use to punch in your zip code and get your Member of Congress and Senator’ names and phone numbers.

Take the Parade poll

In this week's issue of Parade magazine, the editors invite readers to go online and vote whether or not “obese” passengers should buy two seats. So far 83% say yes, 17% say no.

Go vote.

UPDATE: The tally is now Yes 57%, No 43%. Woo-hoo!

Be part of an eating disorders study

If you or someone you love has or has had an eating disorder, you (or s/he) might be eligible to be part of one of these ongoing studies. Treatment is often free if you're part of a study. And you're helping advance the pitiful state of e.d. research, which is always a good thing.

* * *

Have you been affected by an eating disorder in the San Diego area? You may qualify to participate in a study that could help clinicians understand and treat eating disorders. Does the following describe you? You are a girl/young woman between the ages of 13 and 25: you are currently in treatment for an eating disorder; you are medically stable; and you have used the internet to look at ANOREXIA websites. Following a brief telephone screening, you will be asked to fill out a brief survey and participate in a one-on-one interview with a doctoral student from Alliant International University. Your total time commitment will be no longer than 2 hours. All identifying information about you will be kept confidential. You will be compensated with a $20 gift card to Westfield Malls (UTC, North County Fair, Horton Plaza, Plaza Bonita) and will be entered into a drawing for one $150 gift card. For more information contact PattyschroMA@sbcglobal.net.



San Diego, CA: UCSD Researchers Seek Males and Females with Anorexia Nervosa: The UCSD researchers are currently seeking adolescents and adults currently suffering from Anorexia Nervosa to participate in one of their three current studies. To qualify for any of the studies one must be at least 15% below ideal body weight and be fearful of weight gain, despite being underweight. Both adults and adolescents between the ages of 14-45 are needed to participate in a taste study and would be compensated for up to $70 for completing the assessments, taste tests and interview. Adults 18 years of age and older are needed to participate in a randomized control trial of the medication Quetiapine, in which they will receive either the study medication or a placebo. Subjects will be compensated up to $360 for completing study related assessments and the medication treatment. In addition, they are offering several months of family therapy treatment for families with adolescents between the ages of 12 and 18 at no cost. The adolescents in this study will also be randomly assigned to receive either the medication Fluoxetine or a placebo. For more information, contact UCSD Eating Disorder Treatment and Research Program at 858-366-2525 or email edresearch@ucsd.edu.



San Diego, CA: UCSD Researchers Seek Women Recovered From an Eating Disorder: Help UCSD researchers understand what causes eating disorders. They are seeking female participants between 18 and 45 years of age who are recovered from Anorexia or Bulimia Nervosa. By participating in the study, subjects will be assisting physicians and researchers in developing new treatments for these complex and serious disorders. Subjects will be compensated for your participation in this study. For more information contact the UCSD Eating Disorder Research and Treatment Program at 858-366-2525 or email edresearch@ucsd.edu.



Massachusetts Research Study - Massachusetts General Hospital Study of Therapy for Bone Loss in Anorexia Nervosa: The Neuroendocrine Unit of Massachusetts General Hospital is conducting research studies on anorexia-induced bone loss. Their screening study is for men and women age 12-50 with anorexia nervosa. They are investigating causes of osteopenia (or bone loss) in the spine, hip, wrist and total body. The study involves one visit of approximately 3 hours. Their treatment study is for women aged 18-45 with anorexia nervosa and absent or irregular menstrual periods. They are investigating the combined use of a natural hormone and a medication that is effective for bone loss in postmenopausal women as a novel treatment for the bone loss seen in women with anorexia nervosa. They hope that the combination of these two investigational medications will help rebuild depleted bone and prevent further bone breakdown in women with anorexia nervosa. The study consists of 6 visits over 12 months. A stipend of up to $675 is awarded throughout the course of the study. If interested, call Erinne Meenaghan, N.P. at 617-724-7393 or email nedresearchstudies@partners.org.



Massachusetts: Bulimia Nervosa Study: Free confidential treatment is available to those who are eligible. Do you or someone you know binge eat? Do you or someone you know compensate by vomiting or other extremes? Do you or someone you know have severe moodiness or relationship problems? Researchers are now enrolling participants (ages 18-65) in a free treatment study investigating two active treatments, including education and counseling, for bulimia nervosa. If interested call 617-353-9610 or click here.



New York, NY: NIMH-funded, IRB-Approved Study of Adolescents with Bulimia Nervosa (ages 12 - 21 years). This study takes place at NYSPI/Columbia University and compensation is provided for participation ($100). For more information, contact Laura Berner at 212-543-5316. P.I.: Rachel Marsh, Ph.D., Assistant Professor of Clinical Psychology, Columbia University/ New York State Psychiatric Institute, phone 212-543-5384, email marshr@childpsych.columbia.edu.



New York, NY: The National Institute of Mental Health is sponsoring a multi-center international study to compare two types of family therapy as well as fluoxetine or placebo (an inactive medication) in the treatment of adolescents with anorexia nervosa. They are looking for families with an adolescent with anorexia nervosa between the ages of 12-18 years. Participation involves completing assessment interviews, questionnaires, and engaging in 16 family therapy sessions over the course of nine months with medication continuing for another six months. The study is being held at the Eating Disorders Research Program, The Westchester Division of New York-Presbyterian Hospital, Weill Medical College of Cornell University. Contact the Research Coordinator, Samantha Berthod, MA at 914-997-4395.



Pittsburgh, PA: Seeking Women Recovered from Anorexia or Bulimia Nervosa. Dr. Walter Kaye and his research team at the Eating Disorders Research Program at the University Pittsburgh Medical Center are looking for women who have recovered from anorexia or bulimia nervosa for a research study on brain chemistry in eating disorders. Study participants must be between 18 and 45 years old, medication free (birth control pills acceptable) and not pregnant or nursing. The study involves phone interviews, questionnaires, PET and MRI scans, lab work, physical exam, two visits to Pittsburgh and 8 weeks of fluoxetine (generic form of Prozac). (Note: All expenses incurred during the study, e.g. travel expenses, lab work, physical exam and etc. are paid for by the study.) In addition, eligible participants will be compensated up to $1300 upon completion of the study. For more information, email EDResearch@upmc.edu or Dr. Kathy Plotnicov at plotnicovkh@upmc.edu or Dr. Sharon Barnes at barnessd@upmc.edu. Interested parties can also call toll-free at 1-866-265-9289 or submit a contact form online here.

If you live in Scotland, you'd better not be fat

Because if you are, according to the Sunday Herald, your doctor can prescribe Accomplia (generic name: rimonabant) if you haven't "responded to other treatments"--i.e., if you're still fat despite his/her best advice.

That's because Scotland has gone completely bonkers on the subject of fat. Especially when it comes to the children. According to a spokesman for the Scottish National Health Service, "Being overweight or obese during childhood can lead to physical and mental health problems in later life, such as heart disease, diabetes, osteoarthritis, back pain, low self-esteem and depression."

Maybe he hasn't seen this study on how feeling bad about your weight is much worse for your health than actually being fat.

Accomplia, on the other hand, has been linked to depression and other mental health issues, heart attacks, and suicide. Sounds like a perfect "fix" to me.

Thankfully, not everyone in Scotland has leapt onto the anti-obesity train. The Sunday Herald quotes Dr. Ken Paterson, chairman of the Scottish Medical Consortium, as having said, ". . . our advice is that [the drug] shouldn't be used. . . . People regain weight very quickly when they come off this drug, so the real question is what is the benefit of having a short-term, non-sustained weight reduction? We don't believe it should be in general use."

I worry, I really do, about what life will be like here and elsewhere in 10 or 15 years if you're fat.

Why I am a fan of Leora Pinhas

She's a psychiatric director for the eating disorders program at the Hospital for Sick Children in Toronto. At the recent Canadian Pediatric Society Conference, Dr. Pinhas said two things that endeared her to me.

First, she compared childhood eating disorders to cancer:

"We have this thing that [they're] not really serious. But one in 10 will die. We need to act like it's a serious illness."

Thank you, Dr. Pinhas.* And thank you even more for going on to put the question of eating disorders into the context of the ever-more-prevalent obsession with childhood obesity:

Pinhas dismissed the attention being given to childhood obesity rates - which she says have not increased since 2003 and have not increased in any clinically significant way since the late 1990s.

The most disturbing thing about the constant news about obesity rates is it's likely fuelling eating disorders, Pinhas said.

"Dieting is the gateway to eating disorders. If you have people encouraged to diet because being fat is so bad, you're only giving them an intervention that will make them fat, or give them an eating disorder or make them feel bad about themselves."

In the current culture, which supports weight-loss interventions for children as young as 2, Dr. Pinhas' perspective is not just refreshing--it could be a life-saver.


*Though she also went on to say that "most people recover from eating disorders." I'd like to know where that statistic comes from, since the numbers I've seen are far bleaker.

The girl at the mall

I noticed her right away, as I always do now: 9 or 10 at first glance, with the thin, prepubescent body of a girl who hasn't begun puberty yet. On second glance I could see she was older--something about the curve of her shoulder, the way she carried her purse, the look on her face, more knowing than a 9-year-old, and more weary, too. I could see the shape of her arm bones under the skin, the sharp edge of her collarbone.

She was shopping with her mother; I was shopping with my 12-year-old. They were discussing a dress, the very dress, it happened, that my daughter had her eye on. The mother hung it back on the rack and my daughter picked it up. "Look, Mom, I love this!" she said. Then she looked at the size--size 7--and regretfully put it back.

I asked the other mother, "How old is your daughter?"

The mom smiled and shook her head. "She's 12, but she thinks she can wear a size 7. She swears it fits and I told her I'm not buying it."

I looked at the girl, her strained smile, her impossibly thin waist. I looked at the mother. I made a decision.

"Could I have a word?" I asked.

I told her my daughter had had anorexia, that I saw some of the same signs in her daughter I'd seen in mine. I told her that her daughter looked worryingly thin, that wanting to wear a size 7 when you're 12 could very well reflect the distorted thinking of an eating disorder. I told her I hoped her daughter wasn't sick but that if I were her, I would take her to the doctor right away.

By the time I was done talking the mother was backing up. "OK, thanks," she said, edging away from me, and they were gone.

I can't get the girl at the mall out of my mind. I wonder what her mother will do. I wonder if I did the right thing to speak to her.

What would you have done?

If your child has an eating disorder, read on. . . .

I've written before and recently about how eating disorders affect the entire family. E.d.s are incredibly stressful for both sufferers and the people who love them.

So I was interested to see this study, showing that even mild stress, if it's chronic, affects cognitive abilities in rats. It makes them forget things they've just learned and alters their neuroimmune and neuroendocrine systems.

Of course this applies to any families dealing with acute or chronic illness.

Me, I'm glad to know that there were sound physiological reasons for my post-recovery meltdowns. So if your child is doing well (and especially if she's not), and you're forgetful, irritable, can't concentrate--just know that it's not your fault and that there are good reasons for your brain drain.

A headline I couldn't resist

Obesity Researchers May Need Jaws Wired Shut

Warning: There's an egregious fattie picture accompanying this article--not headless but with eyes rolled back in ecstasy? abandon? seizure? as the fork is lifted. But there are some pretty good lines in here.

Big Brother has arrived . . . in Japan

This article made my jaw drop over my morning tea. I don't know why--this kind of government intrusion into private lives is the logical consequence of all the anti-obesity hype we're hearing. It's coming here too, I fear, under the guise of a national health plan that ties "wellness" to "consequences."

But here's the thing: In Japan, talk about eating disorders is very hard to come by. I sit on a committee at the Academy of Eating Disorders with international representation, and the member from Japan has talked repeatedly about how hard it is to get any of the media there to write about eating disorders. And how difficult it is to discuss e.d.s in Japan.

And yet the Japanese government is imposing sanctions on those whose waists exceed a randomly set number?

Once again, the connection between the war on obesity and eating disorders scares the hell out of me. For good reason.

Overweight? Try this

I've been slow to post these days, for which I am sorry. Life is hectic right now.

But plenty of other people have been posting these days. One of my favorites of recent weeks is Carrie Arnold's post from yesterday. It's parody of the best kind--sarcastic as hell and oh-so-true in spirit. Jonathan Swift would have approved.

SOTD*: Teens and "eating problems"

A new study out of Finland and reported in the Journal of Advanced Nursing asked 15- to 17-year-olds to report on whether they had eating "problems" along with a host of other health issues (insomnia, depression, etc.). About 18 percent of teens said they had some level of eating problems that persisted over two years. I'd love to know exactly what "eating problems" means in this context--it could be anything from picky eating to active restricting/purging.

Interestingly, and right in line with other new research, there was a strong correlation between eating "problems" and anxiety/depression:

• 47% of students with persistent problems reported anxiety, compared with 12% of non reporters.
• 31% reported depression, compared with 5% of non reporters.
• 77% were unhappy with their weight and 46% with their appearance. This was much higher than the 8% and 18% reported by students without eating problems.

So far, so good. Researchers went on to look at height and weight records kept by school nurses and "found that even students with persistent eating problems were more likely to be normal weight than over or underweight."

From this they concluded, "Our study backs up previous research that shows that eating problems often fluctuate in children of this age and in 50 to 60% of cases last about one to two years. However in ten per cent of cases their eating problems can persist into adulthood. Although almost a fifth of the students who took part in our study reported eating problems at some point, these problems clearly sorted themselves out in the majority of cases. However, one in twenty students continued to report problems."

I'm not so sure about that. First of all, these were self-reports, and we all know that even under the best circumstances, self-reports are notoriously unreliable. Second, teens with eating disorders tend to be ansognosic--they can't recognize that they have a problem.

It makes me wonder about the teens who said they did have problems, and what relationship those "problems" have with eating disorders.

It's quite a stretch to conclude from this that the majority of teenage eating issues last one to two years and then "clearly sort themselves out." Maybe the kids just got savvier about hiding e.d. behaviors and stopped self-reporting. Maybe the kinds of problems they were describing aren't related to true eating disorders in the first place. Maybe they had some help in resolving those eating problems that wasn't identified in the study.

I'm grateful to see more studies on eating disorders, but sometimes surprised by the level of analysis brought to the table (so to speak).



*SOTD = study of the day

And this just in: Aetna settles!

Remember the class action lawsuit brought by New Jersey mom Dawn Beye, among other plaintiffs?

Well, Aetna, the insurer in question, has just settled. Not only will it pay 100 or so New Jersey families whose e.d.-related claims were denied, but:

For people enrolled in fully insured policies, "Aetna shall cover claims submitted by Aetna Insureds for the diagnosis, care and treatment of eating disorders in the same manner as biologically based mental illnesses," the May 22 settlement in DeVito v. Aetna Inc., civ-07-418 says.

I'm lifting my breakfast fork in celebration here. The Aetna settlement closely follows the Minnesota Blue Cross Blue Shield settlement brokered by a suit involving Kitty Westin some years ago.

This is Progress with a capital P. Go read for yourself.

The "other end of the spectrum"

This article in the Milwaukee Journal Sentinel caught my eye the other day. Whoever wrote the headline--"Young females may be on the path to poor bone nutrition"--missed the real point here, which to my mind is captured in these paragraphs:

One of the most surprising findings was that nearly twice as many of the non-athletes (30%) had poor bone health, compared with the athletes. More than 90% of the non-athletes also were getting insufficient calcium.

The finding shows that while overeating and obesity are problems for a significant number of adolescents, at the other end of the spectrum is a group of young girls who have poor nutrition habits, including not eating enough.

Yes, folks, despite 200+ years of knowledge about eating disorders, we are still surprised to hear that some young women do not eat enough.

Sarcasm aside, I am thrilled beyond measure to read things like this:

"A lot of times we are so focused on obesity that it can play into eating disorders," said Sheila Dugan, an assistant professor of physical medicine and rehabilitation at Rush University Medical Center in Chicago. Dugan was not a part of the study.

Yes, yes, and yes. I am terrified that 5 or 10 years from now, when the children who are now getting a whopping dose of "wellness" curricula in elementary schools hit adolescence, we're going to see a spike in the number of cases of eating disorders.

The last time I tried to make this point to someone In Charge (in this case, a new head of a university hospital's child and adolescent programs), she looked at me like I had two heads.

But osteoporosis is a quantifiable measure. It's not a subjective assessment of eating habits or self-reported nutrition. It's undeniable numbers and for that I am grateful. If that's what it takes to get those In Charge to pay attention, that's a good thing.

Now, who's listening out there?

Research opportunities

Here's a round-up of research opportunities relating to eating disorders. If you're eligible for one of these studies and you feel comfortable participating, I encourage you to do it. God knows we need more research on e.d.s. Do it for yourself and for all those who will come after you.

And let's raise a fork to the end of eating disorders.


San Diego, CA: UCSD Researchers Seek Males and Females with Anorexia Nervosa: The UCSD researchers are currently seeking adolescents and adults currently suffering from Anorexia Nervosa to participate in one of our three current studies. To qualify for any of the studies one must be at least 15% below ideal body weight and be fearful of weight gain, despite being underweight. Both adults and adolescents between the ages of 14-45 are needed to participate in a taste study and would be compensated for up to $70 for completing the assessments, taste tests and interview. Adults 18 years of age and older are needed to participate in a randomized control trial of the medication Quetiapine, in which they will receive either the study medication or a placebo. Subjects will be compensated up to $360 for completing study related assessments and the medication treatment. In addition, we are offering several months of family therapy treatment for families with adolescents between the ages of 12 and 18 at no cost. The adolescents in this study will also be randomly assigned to receive either the medication Fluoxetine or a placebo. For more information, contact UCSD Eating Disorder Treatment and Research Program at 858-366-2525 or email edresearch@ucsd.edu.

San Diego, CA: UCSD Researchers Seek Women Recovered From an Eating Disorder: Help UCSD researchers understand what causes eating disorders. They are seeking female participants between 18 and 45 years of age who are recovered from Anorexia or Bulimia Nervosa. By participating in the study, subjects will be assisting physicians and researchers in developing new treatments for these complex and serious disorders. Subjects will be compensated for your participation in this study. For more information contact the UCSD Eating Disorder Research and Treatment Program at 858-366-2525 or email edresearch@ucsd.edu.

Massachusetts Research Study - Massachusetts General Hospital Study of Therapy for Bone Loss in Anorexia Nervosa: The Neuroendocrine Unit of Massachusetts General Hospital is conducting research studies on anorexia-induced bone loss. Their screening study is for men and women age 12-50 with anorexia nervosa. They are investigating causes of osteopenia (or bone loss) in the spine, hip, wrist and total body. The study involves one visit of approximately 3 hours. Their treatment study is for women aged 18-45 with anorexia nervosa and absent or irregular menstrual periods. They are investigating the combined use of a natural hormone and a medication that is effective for bone loss in postmenopausal women as a novel treatment for the bone loss seen in women with anorexia nervosa. They hope that the combination of these two investigational medications will help rebuild depleted bone and prevent further bone breakdown in women with anorexia nervosa. The study consists of 6 visits over 12 months. A stipend of up to $675 is awarded throughout the course of the study. If interested, call Erinne Meenaghan, N.P. at 617-724-7393 or email nedresearchstudies@partners.org.

Massachusetts: Bulimia Nervosa Study: Free confidential treatment is available to those who are eligible. Do you or someone you know binge eat? Do you or someone you know compensate by vomiting or other extremes? Do you or someone you know have severe moodiness or relationship problems? Researchers are now enrolling participants (ages 18-65) in a free treatment study investigating two active treatments, including education and counseling, for bulimia nervosa. If interested call 617-353-9610 or click here.


New York, NY: NIMH-funded, IRB-Approved Study of Adolescents with Bulimia Nervosa (ages 12 - 21 years). This study takes place at NYSPI/Columbia University and compensation is provided for participation ($100). For more information, contact Laura Berner at 212-543-5316. P.I.: Rachel Marsh, Ph.D., Assistant Professor of Clinical Psychology, Columbia University/ New York State Psychiatric Institute, phone 212-543-5384, email marshr@childpsych.columbia.edu.


New York, NY: The National Institute of Mental Health is sponsoring a multi-center international study to compare two types of family therapy as well as fluoxetine or placebo (an inactive medication) in the treatment of adolescents with anorexia nervosa. They are looking for families with an adolescent with anorexia nervosa between the ages of 12-18 years. Participation involves completing assessment interviews, questionnaires, and engaging in 16 family therapy sessions over the course of nine months with medication continuing for another six months. The study is being held at the Eating Disorders Research Program, The Westchester Division of New York-Presbyterian Hospital, Weill Medical College of Cornell University. Contact the Research Coordinator, Samantha Berthod, MA at 914-997-4395.


Pittsburgh, PA. Seeking Women Recovered from Anorexia or Bulimia Nervosa. Dr. Walter Kaye and his research team at the Eating Disorders Research Program at the University Pittsburgh Medical Center are looking for women who have recovered from anorexia or bulimia nervosa for a research study on brain chemistry in eating disorders. Study participants must be between 18 and 45 years old, medication free (birth control pills acceptable) and not pregnant or nursing. The study involves phone interviews, questionnaires, PET and MRI scans, lab work, physical exam, two visits to Pittsburgh and 8 weeks of fluoxetine (generic form of Prozac). (Note: All expenses incurred during the study, e.g. travel expenses, lab work, physical exam and etc. are paid for by the study.) In addition, eligible participants will be compensated up to $1300 upon completion of the study. For more information, email EDResearch@upmc.edu or Dr. Kathy Plotnicov at plotnicovkh@upmc.edu or Dr. Sharon Barnes at barnessd@upmc.edu. Interested parties can also call toll-free at 1-866-265-9289 or submit a Contact Form online here.

An open letter to parents

Dear Parents,

I know it's hard to raise a child in this day and age for all kinds of reasons. And I know that one of those reasons is all the messages you get about your child and weight.

I know that parents often get shamed, these days, if their child's weight is too high (or too low). That there's enormous pressure for kids to slim down and look a certain way. To fit the current cultural norms around appearance and weight.

But for god's sake, I beg you, don't send your child off to a place like this. If you've ever been tempted to send your child off to fat camp, read this article in the Washington Post. Read about a "camp" where growing teenagerss are forced to eat such a low-fat low-everything diet that eight of them developed gallbladder disease in the last year.* Where six of them needed gallbladder surgery. Where kids routinely douse their food with ketchup and mustard.** Where hungry teenagers drink 12 or 15 cans of diet soda a day, all of it laced with Splenda.*** Where the director of the whole place thinks it's OK if kids gorge on cake occasionally because they'll just throw it up again.**** Where kids are put into "solo" when they break the rules.

Most of all, what a place like this does is reinforce the idea to your child that s/he is not OK as s/he is. That she's acceptable only if she loses weight. That she's not lovable as she is.

And that's the very worst part of this whole trend. As parents, we're supposed to build our children up, not undermine them. We're supposed to be voices of reason in a sometimes crazy world.

So if your child doesn't fit today's paradigm for weight or attractiveness, love her anyway. Tell her she's beautiful and strong and lovable and smart. Teach her to love herself. That's the way to health and beauty. The other will lead her down a lifelong path of hating herself. And I can tell you from personal experience that that's not the way to health and beauty.


*Gallbladder disease can be caused by weight loss that's too fast.

** A classic sign of malnutrition/starvation. The volunteers in Ancel Keys' starvation study did the same. So did my daughter when she was anorexic.

***A friend of mine was temporarily blinded by Splenda. She leaned over a pot on the stove at just the wrong moment, and was blinded by the chlorine gas released from the Splenda-laced concoction. You definitely don't want your child drinking Splenda. Especially not 15 servings a day.

**** As my friend Jane says, hello bulimia.

The real face--and sound--of Russian ballet

The online trailer to David Kinsella's new film about Russian ballet, A Beautiful Tragedy, shows a young woman who is training at one of Russia's premier ballet schools. Against a background of piano music we see her beautiful, expressive face contort with effort as she works. And we hear--most extraordinarily--her panting. It's the sound of ballet, a sound you don't hear from the audience at a performance. It's the sound of a young athlete and artist working to her fullest capacity.

We also see her face, and the faces of several other young dancers in the film. They have the gaunt and haunted eyes, the protruding bones, of anorexia. According to Kinsella, dancers at this school in Russia must keep their BMIs down to about 14. These young, growing girls learn to punish themselves, to starve, to obsess about fat, all in the name of beauty. A particular notion of beauty.

I'm glad I'm not a ballet lover, because I don't think I could sit through another ballet without seeing these girls' faces and hearing, in my mind, the sound of that determined, exhausted breathing.

Childhood obesity: the deconstruction

Over at the Rocky Mountain News, Paul Campos has posted a brilliant response to some of the hyped-up points made in the Washington Post's current (and ridiculously overblown) series on childhood obesity--and issued a challenge. A $10,000 challenge, to be exact, to the lead author of the 2005 study that predicts a two-to-five-year drop in life expectancy "unless aggressive action manages to reverse obesity rates."

Campos rebuts some of the war-on-childhood-obesity's usual points with elegance and clarity. For instance, to put some of the current hyperbole in context, he points out, "Ever since public health records began to be compiled in America in the mid-19th century, the following statement has always been true: Today's children are both larger and healthier, on average, than those of a generation ago."

One of the most commonly repeated predictions by fervent generals in the war on childhood obesity is that because children are fatter today, their lives will be shorter. What could possibly strike more fear into a parent's heart? I think this prediction is at the heart of the current hype, and clearly Campos agrees, because his challenge to the author of the 2005 study involves a more thorough examination of the data:

If, at any decennial census going forward, obesity rates have risen or remained the same, and life expectancy in America has declined, I'll pay [the author] $10,000. If we don't get any thinner but life expectancy has risen, he'll pay me the same sum.

I look forward to Round 2.

Sex and drugs and pharmacies

Over at Junkfood Science, Sandy Szwarc had an excellent post today on the rather incredible prevalence of prescription drugs in America today and the financial motives behind such large-scale prescribing.

Full disclosure: I'm in favor of meds for those who need them. Actually, I often wish SSRIs had been around when I was a teenager. I often wonder who I might have become had I not had to deal with the continuous panic attacks that started around age 11. Living in constant terror shaped me, body and soul. For better or worse.

Still. Some of the statistics Szwarc quotes are staggering: More than half of all insured Americans take some kind of prescription for a chronic condition. (Note that it's 50 percent plus of insured Americans.) Nearly half of all young women in this country now take ongoing meds. Likewise one in three children.

As Szwarc points out, pharmacy benefit managers stand to gain big bucks from the rise in chronic prescriptions. But most doctors don't benefit directly from prescriptions. They have patients' best interests at heart. The trouble is in how one defines best interests.

Case in point: The women in my family tend to have high cholesterol. My mother has it. My grandmother had it. And I've got it. When my cholesterol level first turned the wrong way, my (former) doctor encouraged me to "eat right and exercise." I did, and I do. I'm no fitness queen, but I try to walk or bike for 45 minutes every day, and I try to be active in other ways too. I eat a wide variety of foods, including plenty of fruits and vegetables. None of this affected the cholesterol numbers, which continued to inch upward. Then my doc started trying to convince me to go on statins. Every time I saw her she suggested I give them a try. After about two years of this she sat me down and said, "If you were my sister I'd put you on these right now." She went on to scare the living crap out of me with accounts of young people who'd had heart attacks and strokes. Statins, she said, would prevent all that.

Never mind the fact that there's pretty much no history of heart disease or stroke in my family. None of us are thin. Few of us die early. I've got grandparents and great-grandparents on both sides of the family who lived into their upper 90s.

Still. I was scared. I went on a statin. I felt like crap, but I kept taking it. I never developed the full-blown myopathy that some people get from taking statins, but I did get increasingly depressed and never felt good. Two years later, I got a new doctor, and at our first appointment she asked about the statins. I told her how I felt--scared and crappy--and she took a thorough family and personal history. She told me my risk of having a heart attack or stroke were less than .5 percent, at least at this point, and took me off the statins. Within a couple of weeks I felt great again.

Back when Doctor #1 prescribed the statins, I asked her if she really thought a relatively healthy woman in her early 40s needed to be on cholesterol-lowering drugs for the rest of her life. She looked at me like I was nuts.

I'm sure she believed she was doing the right thing. And I'm just as sure that she wasn't. I guess time will tell.

Sarcastic Saturday

Insurers in Illinois may soon have to cover eating disorders, according to this article from the Chicago Sun-Times.

What a novel idea! Covering treatment for an illness! Why didn't we think of that sooner?

It's official!

Now that the deal has appeared in Publishers Weekly, I am free to announce that HarperCollins has bought the right to publish my next book, which will be a memoir of our family's struggle with anorexia. Working title: BRAVE GIRL EATING. Dr. Daniel le Grange of the University of Chicago has agreed to write the foreword, and my daughter Kitty will write an afterword.

I couldn't be happier. If I can do what I'm supposed to do, the book will be published in spring 2010.

To all the mothers . . .

This is for all the mothers who have watched their children suffer the torments of an eating disorder. Who have been told it was their fault. Who have cried in silence, in darkness, in shame and helplessness.

Your child's eating disorder is not your fault. But you have the power to help her heal.*

On this Mother's Day, I wish you and your family healing and joy and hope. Full recovery is possible. And you are an important part of that recovery. Don't give up. Fight for the child you love who has been taken hostage by the disease. Know that s/he can come back from the brink . . . with your love and your support.




*If you're new to the idea that parents can help heal eating disorders, please visit this site for information and help.

Fat matters

If you're a regular reader of this blog, you know that my family used the Maudsley approach to help our 14-year-old daughter recover from anorexia. (Here's a link to the whole story as published in the New York Times Magazine.)

In Maudsley, parents take charge of their child's eating while they're in recovery. So it was up to my husband and me to devise meal plans for our daughter. Like most anorexics, she needed a lot of calories each day to gain weight--upwards of 4,000 calories a day during one phase of recovery. Because the act of eating was so terrifying and difficult for her, and because, like most anorexics, she endured many stomachaches, our strategy was to get as many calories as possible into the smallest volume of food.

What this meant, practically, was that our daughter ate a lot of high-quality, high-fat and -protein foods: Almond butter. Ice cream. Mac and cheese. (Some of our favorite recipes are here.)

Now this study confirms our instincts about what to feed our daughter. Fat, it seems, matters a lot when it comes to recovery from anorexia. Recovering anorexics who ate higher-density (translation: higher fat) foods were less vulnerable to relapse. I could speculate about why, but the bottom line is that for true recovery, you've got to eat fat. Lots of it. Not just x number of calories, but high-fat calories.

Fat can make the difference between true recovery and a lifetime of suffering.

Fat matters.

Drug money and DSM

Tara Parker-Pope's blog about DSM, the psychiatric bible, and ties to Big Pharma, hits on a point of particular interest to anyone who's had experience of an eating disorder.

The truth is that there are few if any medications that have been shown to help treat an eating disorder, especially in the acute phase of the illness (and isn't that when you want them to help?). Psychotropic meds do not seem to help when someone is severely malnourished through anorexia or bulimia. (There are a few atypical anti-psychotics being looked at for treatment, but the jury is still way out on those.)

Despite the accumulating evidence that meds are not the first-line treatment for eating disorders, pretty much every doc you'd see for an e.d. will prescribe an SSRI, or several.

In my daughter's case, she had bad reactions to nearly everything she was put on, which meant more suffering was piled on top of what she was already going through. Oh, and we had to pay big bucks for it, too.

Of course, my daughter was never officially diagnosed with anorexia nervosa. I'm not sure why; she certainly met all the diagnostic criteria listed in DSM-IV. Parker-Pope's piece suggests that such criteria tend to be overly inclusive and vague. I don't think that's true for eating disorders--on the contrary. My daughter's psychiatrist-in-training diagnosed depression with secondary EDNOS--eating disorder not specified. I don't know if it made a difference in her treatment, but it did saddle her with a diagnosis that was completely inaccurate. I don't know how that might affect her down the road.

Any doc treating eating disorders should know that depression is a typical presentation when someone is acutely ill with AN, and it usually goes away with weight restoration.

I know from friends who are psychiatrists and M.D.s that it's increasingly tough to steer clear of drug money and influence. Even if you refuse the free dinners and concert tickets and cutesy pens and other freebies, as Parker-Pope points out, much of the research in the U.S. is being paid for by Big Pharma. For those of you think that's all right because, after all, everyone wants the Best Thing, think back a month or two to this report about cholesterol-lowering drugs. Drug companies will in fact behave unethically if the bottom line is at stake.

Personally, I don't want Big Pharma writing the rulebook for psychiatric disorders. I'm just not sure how to stop them.

Apparently you can fool all the people all the time

At least that's the story making the rounds about Dove's "Real Beauty" campaign, which was praised to the skies by many FA bloggers and others. According to this story, those unretouched photos of beautiful-but-not-"perfect" women may actually have been, you know, retouched.

I got a good laugh out of the last line of the story:

If only for the excessive amount of self-righteousness that accompanied the PR effort surrounding this ad campaign, let's sincerely hope these retouching allegations are true.

As one of the commenters points out, the company that owns Dove also owns Slimfast. Corporate hypocrisy, anyone?

The virtues of a high-fat diet

Since fat has been demonized so consistently in the media lately, I thought it was worth reporting this study on the link between diet and seizures.

For children with seizures, eating a diet high in fat and low in carbohydrates can significantly reduce the number of seizures they have. Which, when you think about it, is a fascinating bit of information.

People in recovery from anorexia need a lot of fat in their diets to restore normal brain functioning. Something I told my daughter over and over while she was recovering was that her brain needed fat in order to work properly.

It's true.

Fat karma

This study, reported in the New York times, confirms what some of us have known for years: Fat cells, like other matter, cannot be destroyed. Each adult has a certain number of fat cells, and that number remains constant throughout your life. When it comes to anything to do with metabolism, the body seems to be very efficient at seeking out and maintaining a state of homeostasis.

E.A. Sims' famous Vermont Prison Studies found that prisoners who were fed 75 percent more than normal gained relatively little weight, and quickly returned to their normal weights when their normal eating resumed, we've understood this mechanism. Notice that the word their is highlighted, because, as we know, there is no one weight that's "normal" for everyone.

So it's not surprising to find that the number of fat cells in an adult human remains more or less constant. But you can bet your sweet tooth that corporations--I mean obesity researchers--are going to keep scrambling to find ways to change that magic number.

So far, every effort we've made to futz with metabolism has either been unsuccessful or backfired and created more harm than good. Maybe we'd do well to take a more Buddhist approach: Your fat karma is unalterable, at least in this lifetime.

Deconstructing Self

If you haven't seen Sandy Szwarc's cogent analysis of the much-touted Self magazine eating disorders survey, get thyself over here right away and read it. Sandy's done a brilliant job at unpacking some of the most subtly disturbing elements of this "report" on women and disordered eating and on how it's been received. The cognitive disconnect she highlights refers not just to this particular study and the reactions to it but the disconnect we all experience of living in a society where food and eating and what we look like are bound up with so many judgments and with our most essential feelings about ourselves.

Food for thought indeed.

More scare tactics?

This story from the AP adds yet another entry to the annals of fat and thin. It covers new research that claims to show that fat-but-fit is a figment of the fatties' imagination.

The new study followed some 39,000 women with an average age of 54 over a period of 11 years, tracking their weight, levels of physical activity, and incidence of heart disease. Says the article:

Compared with normal-weight active women, the risk for developing heart disease was 54 percent higher in overweight active women and 87 percent higher in obese active women. By contrast, it was 88 percent higher in overweight inactive women; and 2½ times greater in obese inactive women.

Makes you want to start that diet now, right? But it's important to note that the women in the study were self-reporting their levels of physical activity, and self-reporters tend to overestimate when it comes to things like how much exercise they get. Steven Blair of the University of South Carolina points out that fat people who passed a treadmill fitness test did not face higher mortality from heart disease, a fact that seems to support the self-reporters' loophole.

Despite this study's sensationalized headlines, we still have no idea what is and isn't true when it comes to fatness, fitness, and mortality. But we do know that on the whole, diets don't work; that being physically active is better for your health than being sedentary; and that, as Ellyn Satter has shown time and time again, it's much better to be a competent and joyful eater than to be obsessed, anxious, and fearful around food.

So don't despair when you come across this study and the many news reports about it. Read it in context, understand what it does and doesn't say, and dance as much as you want.

Facebook me

I've finally been dragged into 2.0, not exactly kicking and screaming but certainly clueless. Which is another way to say I've got a Facebook page now and could use some Friends. So if you're out there, look me up, would ya? Maybe we can get a new group going.

Another book the world doesn't need

Spring is here, and I've been feeling mellow. A new book deal is proceeding apace. Life is good. I was beginning to think I'd used up my quotient of outrage for the year.

And then Maggie sent me this.

"This" is a book written by a plastic surgeon, aimed at kids to explain their mothers' plastic surgery.

As you can see from the sample panel I've included, it's worthy of outrage on many counts, including lousy illustrations and self-serving, poorly written text. Amazingly (or not), it's gotten quite a bit of national press, much of it rather positive.

I'm giving it two thumbs down. I only wish I had more than two hands.

Penny wise, pound foolish

That truism can apply to so many corporate decisions, can't it? But when it comes to treating eating disorders, the truism becomes both literal and deadly.

Take the case of this Connecticut family, fighting for their insurance company to do the right thing and cover treatment of their 17-year-old daughter's anorexia. While insurance covered her previous treatment, her last admission was kicked out because of a treatment delay that triggered a "within 3 days" rule.

In fact, treatment delays are common and are usually--as in this case--the result of a shortage of beds or space in treatment programs. There's nothing a family can do to prevent them. To have coverage denied because of such a delay--a delay that can be lethal to the adolescent being treated--is both cruel and immoral.

Readers of this blog know how I feel about the health insurance industry: Any industry that profits from people's pain and suffering should be abolished. Until that day, the industry should be held accountable for decisions like this one, which risk lives and add suffering for families already dealing with the torments of an eating disorder.

The girl in question said it best: "If someone needs help, give it to them. Because people don't ask for help if they don't need it. Trust me."

This is especially poignant given the fact that so many people with anorexia cannot recognize that they're ill or ask for help.

Our former insurance company denied coverage for much of my daughter's treatment because we live in a state without mental health parity. (One more reason why I can't wait to move back to New York.) As we know, there are people whose entire work life consists of looking for reasons to deny people coverage. How do they sleep at night?

I hope folks from the company in question read this. And I hope they do the right thing. For once.

Race and place (off-topic)

So after 16 years of living in the midwest--a place I hated passionately for at least the first 6 or 7--I've come to appreciate some of its finer points. Like the access to nature. The relative cleanliness of my small city. The neighborly feeling on our block and on many blocks.

I'm actually going to miss all that when we head east to Orange Country this summer. But there are things I won't miss, like the totally whitebread nature of our small city.

We bought a house this weekend (a house!) in the university neighborhood, which, unlike the one in this small midwestern city, is gritty and urban and integrated. I remember when we moved here from Manhattan's Lower East Side. I remember thinking, Where are all the African American people? They're here, of course, but there's not much integration here. People divide along race and class lines. I don't think I've made a single black friend since moving to the Midwest.

On our new block, on a chilly Saturday afternoon, we saw two kids on bikes. One was learning to ride. The other was running along beside her friend, holding on. Both were black. Both were adorable. A few minutes later we were able to meet one of the families on the street, a white couple in their late 50s with two soon-to-be-adopted African American daughters, former foster children. They were friendly-ish, and I'm looking forward to getting to know their family better.

Right now, our move seems scary and ridiculous. I mean, why change everything when we're relatively comfortable? So what if I don't love my job? How do I know I'll like the new one any better?**

But another part of me looks forward to adventure and change and challenge. Or at least it will when I can shake this damn midwestern flu we've all had going for weeks now.

Our new house has no fireplace (even though we've hardly used ours I like having it) and very little yard, but it does have a pantry, which will be lovely once we've gutted and redone the kitchen, redone the roof, stripped the godawful paint off the woodwork, installed full-size toilets (for some reason the previous occupants put in teeny-tiny toilets; maybe they all had teeny-tiny tushies), redone the attic, propped up the carriage house in the backyard (which Mr. Professor is thrilled to have), and a few other things.

I'm going to grow some things in pots this year in the front yard. Next year we'll figure out how to put in some raised beds somewhere. I'm a rotten gardener but I love picking veggies out of the backyard.

There's a metaphor in here somewhere, but I'm too congested to figure it out.



**The boss thing I already know is better. My new department chair is fabulous--warm, friendly, outgoing, funny.

For readers in the U.K. . . .

Maybe you've already heard about Scarlet Magazine's campaign to ban fat jokes on TV. As editor in chief Sarah Hedley puts it:

Ordinarily, I’m a big fan of Alan Carr, but I only got as far as the second episode of his new Channel 4 show Celebrity Ding Dong before I began to feel uncomfortablewith the format. Pitting celebs against ‘civilians’, as we’re referred to on the show, is one thing, but having a laugh at the expense of the morbidly obese is quite another. Sadly this is what viewers were expected to do in episode two when Davina McCall and team were asked which was bigger, Posh Spice’s waist or obese civilian Tracey’s arm. The celebrity team hazarded a guess, then Tracey was brought on set and measured to prove just how big she was, while the world was invited to point and laugh.

She then goes on to compare obesity to cancer, unfortunately. Still you have an opportunity to sign a digital petition on the subject if you like.

Makes you wish for the good old days of Benny Hill, now, don't it? :-)

Wow

What an outpouring in response to yesterday's Times piece. I had no idea so many people had gone through the same kind of experience. I heard from many, many parents who had nearly lost a child through illness or accident, and from a few who went through the same set of feelings around a parent or sibling.

So I just wanted to say thanks to everyone who wrote and shared a bit of their story with me. You reminded why it is, exactly, that I am a writer. Writing makes me feel not so alone--and I hope it does the same for some of you.

New piece in the New York Times

Here's the linky. Enjoy. And let me know what you think.

Thank you, Canberra Times

for publishing this opinion piece about the connection between anti-obesity hysteria (my word, not theirs) and eating disorders.

Thank you for pointing out the real and tragic human anguish behind eating disorders. Thank you for daring to question the tactics, if not the content, of campaigns against fat.

And thank you for this last line:

. . . let us not forget to protect the innocence and confidence of a child's innate self-image.

Amen.

Recovering from anorexia: a parent's journey

I've come to realize that this is the year I'm recovering from our family's struggle with anorexia. It's been just about three years since my daughter Kitty got sick. She's been physically healthy for nearly two years, and mentally healthy for almost that long. She's happy, engaged in the world, healthy in every measure. For her, anorexia is thankfully in the past.

For me, though, it still feels very present. It took me a while to realize this because things are so positive.

It's little things that trigger the feelings for me right now. Things like the image above, which appeared in our local paper recently as part of an article about a student art show at the university here. It's called "The Fruit Eaters," by student Aniela Sobienski, and looking at it puts me right back in the land of anorexia.

Another trigger: Last night we went to see the movie Miss Pettigrew Lives for the Day. Great movie, about a proper middle-aged woman who finds herself in unusual circumstances. (Go see it. It's worth it.) Every time the main character tries to eat something it escapes her--it falls on the ground, someone knocks the food out of her hand, etc. In one scene she's having a facial; the attendant puts two slices of cucumber on her eyes and walks out. Closeup to her face, which is covered in goo that makes it look bizarre and distorted. Miss Pettigrew looks around and then eats the two cucumber slices. The look on her face is positively blissful.

Me? I was right back in anorexia land.

Maybe some of this reaction is because I am writing the book about our family's experience that I've been wanting to write for a while. It's a useful catharsis for me and, I hope, useful for others.

I can't imagine what this process of recovery is like for parents who have been pushed out of their child's recovery. Who have been the victims of "parentectomy." I am so grateful that we went the route we did in helping our daughter through anorexia.

Can eating disorders be prevented?

Laura Eickman thinks so. She's a Psy.D. with a private practice in Kansas who makes presentations on what she calls the danger zone, which she defines as the area between eating disorders and "healthy" behaviors. (Which, by my reckoning, is everything else. But I digress.)

Eickman gave a talk recently at Pittsburg State University, a fact that caught my eye because of her emphasis on prevention. The question of whether prevention efforts are effective is a controversial one; some say that few to none show any tangible results, while others see value in certain kinds of interventions.

It's a question that weigh heavily on my mind. Could my daughter's anorexia have been prevented? Her younger sister is at greater risk of developing an eating disorder now; what, if anything, can be done to prevent it?

I don't think Eickman has any answers, at least not judging from the news articles about her presentations. (I haven't seen them myself.)

This quote, from Collegionline, the PSU student independent online paper, disturbed me greatly:

Eickman says people in the danger zone take only one to two years to treat, while those with fully developed disorders take five to six years.

As I have reason to know, at least the last half of that sentence is a lie. My daughter was weight restored from severe anorexia in 11 months; her mental recovery took another 6 months or so. Today, about 3 years after she developed anorexia, she is healthy and happy, with a positive relationship to eating, food, and her body, thanks to the fact that we used family-based treatment to help her recover.

Maybe it's PTSD on my part, but I don't trust "experts" who make statements like the one attributed to Eickman. And somehow I suspect her so-called prevention program is little more than words.

Which is too bad. Because God knows we need prevention that works.

Feminism and the pressure to be thin

Celtic Chimp posted this comment on another thread, and it inspired me to write a new post:


I have never understood how women can have such a wrong impression of themselves. Healthy, beautiful women obsessing about their weight. If women could just see themselves from a blokes perspective for five minutes they would be very confident! I and most men I know find very thin women to be extremey unattractive. Now I'm not saying it is all about what men want or that that is why you lot do the whole weight thing but it is most perplexing to us men-folk. Whilst I agree that aiming that sort of complete bollox at young girls is completely irresponsible, I do think that adult women have got to take some responsibility and teach girls a little common sense. Maybe when their mothers stop fretting about their weight and image so much they will follow suit.

Well, Celtic Chimp, here's the thing: The pressure to be thin is not about what men want. It's not about sexual attractiveness. It's about power.

As you point out, many men--maybe most men, I don't know, as I'm not a man--do not find extreme skinniness sexually attractive. So the thin-is-sexier argument doesn't wash. Most men I know want women to look like women, not prepubescent boys.

No, this is about power. It's about wanting women to be small in the world, to take us less space, literally and metaphorically. This of course is not a new idea; it's one of the underpinnings of first wave feminism, and sadly it still holds true.

I think there's something else going on here, too. I think so long as women are obsessed with our weight and eating and body image, we aren't focusing on other, much more important things. Anyone who's ever had an eating disorder can tell you that while you're in the grip of one, you have no energy or concentration or ability to frocus on anything else. An eating disorder is a kind of closed loop. A dead end. Something to keep the circuits busy so they don't go exploring.

I think the cultural norms today around women and food and eating amount to an eating disorder, or at least highly disordered eating. Women's "place" used to be in the home; that was the 19th-century way to keep women down. Now, maybe, dieting and exercising and obsessing over weight is taking on that role.

Either way, the result is the same. So long as we're busy weighing ourselves, we will never measure up and never get any bloody real work done in the world. In that sense I think you're right: We, women, have to stand up to the culture, reject the pressure to be thin, protect our children from it.

It's not easy to swim against the current. But it's necessary.

So thanks for making the point. I'd love to hear what my readers think.

You tell 'em, Daniel Engber

In this article from the Dallas Morning News, Engber deconstructs a couple of the myths of the obesity "crisis." Nothing particularly new, but nice to see it in a big paper/national format.