Full

Lunch today was a delicious salad nicoise, not unlike the one pictured here. I ate nearly all of it, stopping because I was full.

Why am I telling you this? Because it's been about 7 months since I have eaten and felt full. Not because I'm starving myself but because I've been taking an anti-depressant that messes with my metabolism. I knew it would have this effect. I knew this intellectually, but still, over the last few months, I've struggled with various kinds of fallout from never feeling full.

You eat more when you don't feel full. Especially if you are, like me, a person who likes food and likes to eat. Normally food stops tasting good as you begin to feel full. But if you never feel full, the food keeps right on tasting good, and it's an effort of will and intellect to stop eating.

I say that I knew this medication would have this effect. What I actually mean is that I think it has this effect on me (and on others). But part of me didn't buy it. On some level I've been flagellating myself for the last few months for eating so much and never feeling satisfied.

We do such a good job in this culture of conflating appetite with gluttony, with greed, with being out of control in a scary way; I don't know if it's possible to think of appetite in neutral terms. Certainly it isn't for me. Certainly it's been tough to say to myself, "The little thingy in my brain that signals satiety is not working right now." Much easier to say to myself, "What a greedy, insatiable fill in the blank I am."

So along with that feeling of fullness today came another feeling: relief. It feels good to feel full. It's satisfying.

But it's disturbing to feel this kind of relief. I may very well have to back on this medication, or one like it, in the not too distant future. Part of me says unh-unh, never doing that again, I don't care what the consequences are. But is that really true? Would I rather be thinner and more depressed? Thinner and more anxious?

The questions make me think back to this study, which found that people would rather give up years of their life, be severely depressed, lose a limb, go blind, be unable to have children, if they could only be thin.

I think of myself as smarter than that. And yet--it feels good to be full again.

Listen up

A few weeks ago I did a radio interview for a show called "A Touch of Grey." You can now hear the interview online here. (Scroll down to "Harriet Brown.")

If you haven't written an Amazon review of Feed Me! yet, I'd love it if you would. (Even if you didn't like the book.)

Happy spring!

Al has ham. Al is a fat cat. As is a sad fat cat.

Thanks to blog reader Joan M. for sending me the following:
I have a 5 year old and I am teaching her to read. I have a program made by a company called Frontline Phonics. They have a book called "Ham and Jam": Al is a cat (happy smiling cat), Al has ham (happy cat eating), Al has jam (happy cat eating), Al has ham and jam, Al is a fat cat (cat now has distended belly and is frowning), Al is a sad fat cat, Al ran. Al ran and ran. (cat on the treadmill) Al is a cat. (happy thin cat again)

And the questions that the parents are suppossed to ask after they have read the book are: What made Al so fat? What did Al eat first? What did Al do to become thin again? Why is Al smiling?

Talk about teaching kids while they are young to associate fat and sadness and thin with being happy.

Let's tell the story another way:

Harriet is a blogger. Harriet reads about books like this. Harriet feels sad. Harriet feels mad! Harriet's head feels like it might explode. Harriet swears at the screen. Bad screen. Bad books. Bad thinking.

Any of you come across similarly egregious books aimed at early readers? Inquiring minds want to know.

Kudos to Salon and Kate Harding

for this piece on the new study just out from England that may finally shut down the "Anorexia is the mother's fault!" argument. (You have to register on the site to see it, but you can get a free day pass.)

The study looks at brain development in utero, and reinforces the notion that genetics and neurobiology are the biggest culprits when it comes to why some kids develop eating disorders. As Harding writes:

Ian Frampton, a pediatric psychology consultant and co-author of a study to be presented at a conference at the Institute of Education in London this week, says, "Our research shows that certain kids' brains develop in such a way that makes them more vulnerable to the more commonly known risk factors for eating disorders, such as the size-zero debate, media representations of very skinny women and bad parents." The Guardian reports that based on "in-depth neuropsychological testing" on over 200 anorexia patients in the UK, US, and Norway, Frampton and his colleagues found "about 70% of the patients had suffered damage to their neurotransmitters, which help brain cells communicate with each other, had undergone subtle changes in the structure of their brains, or both." In the past, researchers often assumed that anorexia causes changes to sufferers' brains, but these findings suggest that it works the other way around.

One caveat: If you value your sanity, don't read the comments. Unless a huge surge of adrenaline would be a positive development in your evening.

*Full disclosure: Harding mentions Feed Me! in the piece. Thanks, Kate!

Help for bulimia

I know from personal experience how family-based treatment (FBT, also known as the Maudsley approach) can work in treating anorexia. I'm thrilled that the evidence is mounting for its effectiveness with bulimia, too, especially for teens with bulimia.

But don't take it from me! Maudsley Parents has been putting together information on bulimia and its treatment, which you can see here.

Both Stanford University (where Dr. Lock teaches and researchers) and the University of Chicago (where Dr. le Grange is based) are recruiting teens for bulimia studies right now.

Here's a video of Dr. James Lock, who literally wrote the books (along with Daniel le Grange) in the U.S. on FBT, talking about bulimia:

Rant ho

Now that we bloggers have come to represent the new media, we get a lot of the same kinds of PR stuff that used to go to newspapers and magazines--press releases about new products, upcoming events, etc. Occasionally I find something of interest.

More often, I cannot believe someone sent whatever it is my way. Take, for instance, the email I got today. Subject line (cue drumroll):

Could the Recession Be Making Us Fat?

Gee, I thought we were already too fat--in the midst of an obesity crisis, as a matter of fact. The recession's only been around a year at most. So, I don't know, no?

The email goes on with predictable idiocy to quote a nutritionist saying that in "uncertain times," people "crave rich foods." That's merely banal. The truly enraging part comes next:

"Eating disorders like anorexia nervosa and bulimia are also on the rise. "

Since the prevalence of anorexia and bulimia has been pretty constant for as long as we've been diagnosing them (about 1 percent for anorexia, 2 to 3 percent for bulimia), I'd love to know where this nutritionist is getting this shocking new information. Maybe from the bullshit fairy?

The journalist in me recognizes what we call "fudging" when I hear it, and this is pure fudge--the kind of unsupported generalization people offer up and that too many people believe because, um, it sounds like the fudger knows what he's talking about.

And here's the kicker:

"Both illnesses are tied to stress, depression and the need for control, which is a direct link to the sentiment of many Americans during this recession."

Oh really? Notice the fudging language here? EDs are "tied to" stress and depression. They sure are. So is cancer and heart disease. And then we get the twist of the knife--that old "need for control" crap that's been trotted out routinely ever since Hilde Bruch started writing about anorexia.

The whole thing is actually shopping this unnamed nutritionist as an authority on--wait for it--losing weight.

Yeah, this guy is a real authority, all right.

Note to PR flacks: Do the research before you send out crap like this. You're doing your clients way more harm than good.

Next time I'm naming names.

Just because you're paranoid doesn't mean they're not out to get you

The world of eating disorders treatment is changing. Slowly. Infinitesimally. Minusculely. But change is creeping in.

Still, most ED patients and their families get smacked upside the head at some point with the old assumptions and stigmas about these illnesses.

Such as: Eating disorders are caused by cold or overcontrolling mothers; the child has no other way to establish a sense of autonomy, so she stops eating.

To their credit, many docs have left this one behind. Some say they've left it behind but still on some level believe it. And now I have an inkling into why: A friend who's in med school, and who just finished the hour or two devoted to talking about eating disorders in the curriculum, reports that this outdated and discredited point of view is still in the textbooks.

So on some level, these stigmas are still being perpetuated. Big surprise, I know. But you know, it was a surprise. I'm enough of a good girl academically that reading something in a book makes it shiny and important.

I feel pissed off and sad, though, at the thought that this kind of perspective is still living out there in print, for new generations of baby docs to read and take in. Especially since most of them get almost no training in treating eating disorders anyway. So this might be all they take away from med school on the subject. And it's wrong.

Of food revolutions and politics

This article in today's New York Times poses the question of whether the time is right at last for a revolution in the way we grow, buy, distribute, and eat food. A perfect storm of factors, argues the writer, is brewing to make this happen: Economic hardship, political leaders who value sustainability and an older-school farming ethos, and an ever-more-complex web of relationships between those who grow food and those who eat it.

Is it, as Michael Pollan has suggested, time for a reform of our entire food system? Is this the moment to move toward the Alice Waters model of growing and eating local? I hope so.




The agribusiness lobby has had Washington's ear for the last eight years. I hope the new administration can hear something else now--the concerns of small family farmers, organic farmers, parents who want to feed their children (and eat themselves) high-quality food. One of the biggest obstacles to meaningful food reform in this country has been the fact that only the relatively wealthy have access to good food. So I'd like to see policies that broaden that access and make it possible for poor and inner-city consumers to buy local fruits and veggies, organic meats, and food that's grown to taste good rather than to last 4 weeks in a crate on the back of a truck.

Why am I writing about this here, you might ask? Because eating local food, organic food, food that bloody well tastes good, is a crucial part of learning once more to celebrate and enjoy food. It's a back door into my obsession with the joys of eating and of being comfortable with your body.

OT: The Hebrew Mamita, Yo

Def poetry and you don't look Jewish. Rock it.

Here's one little gizmo I won't be buying

The HappyHR (I kid you not) continuously calculates the amount of calories you burn. Even, um, when you're asleep.

"Stay fit and be happy" is the slogan dreamed up by the Georgia Tech students who are building this gadget. I think they've got the wrong slogan there. How about "Think you're obsessive about eating now? Wait till you wear one of these babies."

I can already imagine the new eating disorder that will grow out of this. Calorexia, anyone?

If the U.S. were my students, they'd flunk

The National Alliance on Mental Illness recently released a report card on America's health care system for adults with mental illness. Our grade: D.

At the Newhouse School of Public Communications, where I teach, this is a failing grade. We flunk when it comes to creating a support system for people with mental illness. We have no network of consistent services, no consistent access to mental health care, and no standardized system of licensing or treatment criteria.

We fail in other ways, too. We as a society fail to take seriously the ravages of mental illness. We step over those with mental illness both literally and figuratively. We turn our faces away. We perpetuate the shame and stigma of diseases like schizophrenia, bipolar disorder, and, yes, eating disorders.*

My students always want to know how they can raise their grades. I put the same question to all of you: How can we as a society raise our grades when it comes to mental illness?

Here's my two cents on the subject:
1. Offer incentives to those studying to be doctors and therapists. One reason we have such a staggering lack of good mental health providers is that in our current health-care system (or shall we say lack of health-care system) they can't earn as much as other docs. This is partly a function of how our disgraceful so-called health insurance system works. See 2.
2. Mental health parity is a good first step, but it's full of loopholes. Enact legislation that prevents health insurers from weaseling out of covering mental health issues. The track record is dismal, especially for eating disorders.
3. The first two items on the list would start us on the road toward lessing stigma around mental health issues. Shame on the health insurers for heaping more shame, and financial burden, on families struggling with these issues.
4. Talk, talk, and more talk. The more we talk about a subject, the less shameful it becomes. Social change takes time. Let's get started.

What are your ideas?





* I'm not a believer in classifying eating disorders as mental illnesses, but for now that's where they reside and so that's where we've got to live with them.

A challenge to my readers

A front page article in yesterday's New York Times made me weep. (I've chosen not to upload the photo that ran with it because it is so very distressing. But please read the article.) It's one of the things I love most about journalism: Its ability to shake readers up and make a story personal. Agenda-setting, we call it--telling readers not what to think but what to think about.

I know that children around the world are hungry. But somehow this one image and story brought home the issue vividly and powerfully.

There are children right here in the U.S. who are this hungry, of course. Probably right in your hometown--no matter where you live.

So here's my challenge for the day: I'd like those of my readers who can afford it to make a donation--no matter how small--to an organization somewhere in the world that feeds children. It could be the U.N.'s World Food Programme, which is working in India. It could be Feeding America (which used to be called America's Second Harvest), which addresses hunger here at home. It could be Mazon, a national nonprofit agency that describes itself as a Jewish response to hunger, or any one of dozens of other anti-hunger organizations.

Give money if you can. Bring a can of soup to your local food pantry if you can't. But do something--today. And then please check back in and let us know what you've done.

Put your money where your heart is . . .

and consider making a donation to the Academy of Eating Disorders' 2009 scholarship campaign.

One of the sad truths in the field of eating disorders is that there just isn't enough research being done. That's one reason for the relatively ineffective treatments we've got--there's not a lot of money to be made by researching EDs, probably because pharmaceuticals don't typically do much to help. So researchers--especially young researchers--have to find other ways to support their work.

One of the things I really like about the AED as an organization is the ways in which it nurtures research. And this is one of them. Since 2002, the scholarship fund has helped fund more than 50 clinicians and researchers from around the world to work on finding solutions for eating disorders. It's a worthy cause--and tax-deductible, too!

Dietitians and fat bias

This study, which shows that dietitians (like doctors) suffer from a significant amount of fat phobia, does not surprise me. Why should dietitians be different from any other group of medial professionals?

One or two sessions with a dietitian is really all it takes to learn the necessaries on nutrition for someone recovering from an ED. Yet our family--like so many others--was told to make weekly appointments with a nutritionist.

As it happens, the nutritionist we saw was not fatphobic; she was just ignorant about how to talk to my daughter. In fact she was a very tall and large woman who told Kitty, at our one and only appointment, "Don't worry, honey. I used to have an eating disorder too, and look at me now."

It was almost funny, really, except that it took hours of reassurance to get my daughter back on track.

Which is why I like to talk to medical professionals--not just about eating disorders but about attitudes toward fat, obesity, and "wellness" curricula in schools.

So if you know of a group of doctors, nurses, nutritionist, or other medical professionals in training or in practice who could benefit from a talk, let me know.

Sadly, this is very funny

Bratz Dolls May Give Young Girls Unrealistic Expectations Of Head SizeThanks to Jane for linking me to this hilarious (and thought-provoking) video satire from the folks who bring you the Onion.

What I want to know is how the actors pulled off their lines with straight faces.

Or maybe it's not that far off the truth. . . .

Looking for women with autoimmune disorders, PCOS, lupus, IBS, fibromyalgia, chronic fatigue for a story

I'm doing a story for HEALTH magazine on diseases that a) disproportionately affect women and b) have historically been unrecognized, under-treated, or generally pooh-poohed by the medical establishment, but are now being recognized and/or taken more seriously. I'd like to tell several personal stories as part of the bigger piece.

So if you have had or still have any of the conditions above, or anything similar, and would be willing to let me interview you and possibly tell your story for the piece, please email me at hnbrown at syr dot edu.

Many thanks.

Seeing red

As a professor of journalism, I read a lot of media. And some days, what I read makes me feel downright ashamed of my industry. Today is one of those day, and the triggering story is this one, from the Washington Post.

The piece is written by a young woman who discusses the power of a parent's words to trigger an eating disorder. I have nothing against the writer; it's a heartfelt and I'm sure honest piece of writing. The writer attributes her three-year course of bulimia to a critical comment about her weight from her mother. The piece goes on to list "resources" for parents, presumably to prevent them from doing such things in the future.

I'm not defending this mother's comment. Far from it. I grew up in a family where comments like these were fairly commonplace; I know how hurtful they can be. My problem is with the editors of the Post, who did not do their homework. They accept this premise as if it were 100% true and present no other point of view. There's nothing in the story to contradict the notion that a parent's comment can in fact trigger an eating disorder. There's nothing on the heritability or biological roots of eating disorders, on the neurochemistry of starvation and purging. Readers are left with the sense that a stray comment, especially from a mother (always the mother), can cause the nightmare of an eating disorder.

Had the editors of the Post looked at any of the recent research on eating disorders, they might have been inspired to add another perspective to this young woman's story. Had they stopped to think about it they might have realized that if a parent's words were truly that dangerous, we'd have many more cases of eating disorders to contend with (because God knows parents say hurtful, stupid things all the time, myself included).

The irony is that this piece ran in a package along with an excellent piece written by Carrie Arnold, whose blog Ed-Bites and books are both well-researched and moving. Arnold's piece is informative, but its headline and deck--"Extreme Measures: When Kids' Size Is a Problem, Parents Seek New Solutions"--written by the editors, are misleading, possibly deliberately so. Since when are anorexia and bulimia a problem of a child's size? Hello, do the editors here know anything at all about eating disorders? Do they not care? This kind of thing perpetuates the destructive myths around eating disorders--that they are "about" appearance, that they aren't serious health issues, that they happen only to the children of overinvolved and overcritical parents.

Fact: Eating disorders happen in all kinds of families--rich, poor, white, black, Latino, overinvolved, neglectful, respectful, authoritarian, authoritative, permissive, large, small, functional, dysfunctional.
Fact: Eating disorders are complex and multifactorial. We don't understand their origins. We do understand that blaming parents is both unhelpful and unhealthy--and often untrue.
Fact: The family is almost always a child's best chance at recovery.

The Washington Post's concept of families seems about as outdated--and harmful--as the photo above.

I shouldn't be seeing red right now. I should be used to this. Somehow I never get used to it.

Cupcakes and conversation

If you're anywhere near Syracuse, NY, this Thursday, please stop over at the panel discussion and book signing for Feed Me!. The book includes fabulous essays from some of my favorite writers, including Joyce Maynard (whose poignant memoir about making pie with, and then for, her mother still makes me tear up), Caroline Leavitt (who wrote a haunting piece about men, power, grief, and food), Diana Abu-Jaber (writing about the culture clash between Bedouin and American eating habits), and many others.

We'll hold a panel discussion with Mary Tantillo of the University of Rochester's Eating Disorders Program and Cris Haltom of Ithaca, both of whom speak eloquently about food, eating, and related issues. And yes, there will be cupcakes. I'm not saying they'll live up to the perky frosting on this one, but, you know, a cupcake's as good a reason as any to come out on a chilly night.

If you don't show up, I'll have to eat all the cupcakes myself.

The stigma of mental illness

This piece, from my local paper, is both horrifying and provocative. The writer, Joyce Gramza, tells how her daughter, who has paranoid schizophrenia, was punished--in the hospital, awaiting transfer to a residential facility--because of her illness. It's an upsetting story.

What's even worse, as Gramza goes on to catalogue, is that her daughter's case is not an anomaly. Rather, it reflects a level of proven prejudice among doctors, nurses, and other medical professionals. Even for those who should know better, it seems, the stigma of having a mental illness can diminish the level of care, both physical and psychological.

An old friend of mine had a brother who was schizophrenic. I knew Steven as a talented musician whose dreams of becoming a composer never materialized but who made a life for himself despite his illness. Steven was in his 40s and receiving treatment for colon cancer when he died. The autopsy showed that he had literally no white blood cells left. The chemo that was supposed to help him killed him, because no one had monitored his white cell count.

Might this have happened to a patient who was not schizophrenic? Sure. But it happened to Steven. And he was not alone. The studies Gramza cites demonstrate that this kind of dropping the ball on care happens to a lot of mentally ill patients.

My hope is that more people will advocate for their mentally ill loved ones, whether the issue at hand is a mattress to sleep on or proper bloodwork. In the middle ages, people feared that they could catch mental illness from touching someone who had it. Our attitudes today, sadly, have not evolved very much.

Write a review?

Hey y'all, I'd love to see a couple more customer reviews of Feed Me! up on the Amazon site. (Good ones are preferable, but say what you really think.) Would you consider sending one in for me? It doesn't have to be long or fancy--just whether you liked the book and why.

Thanks. Really.

Join the Rebellyon

Thanks to my friend Erik for sending me a link to this story about musician Amanda Palmer, whose record label, Roadrunner, told her that her stomach looked too fat in a new music video and that they needed to digitally slim it down.

Palmer's response: Love thy belly. Her fans jumped on the belly wagon, creating a "rebellyon" that includes a website where you can upload a photo of your own belly, inscribed with a message to the world.

This story is interesting both for its element of cultural body dissing and for its feminist subtext: Apparently one of the record label execs told Palmer, "I'm a guy. I know what people like."

Yeah, I'm a woman. I don't know what people like. I don't know what my own body looks like. And I sure as hell don't know why I'd ever buy another Roadrunner record. Except, of course, for Palmer's latest.

OT: Help a Syracuse University student

One of my students is looking to interview children of alcoholics for her honors project--especially those under, say, age 25. Anonymity is yours if you want it; she's a sensitive interviewer, as she herself comes from an alcoholic family.

If you'd be willing to talk with her for this project, or know anyone else who might be, please contact Theresa Walsh at tewals01 at syr.edu.

I thank you.

EMAIL ADDRESS HAS BEEN CORRECTED.

Revolutionizing the runway

Last Sunday I was lucky enough to be able to take both my daughters to what was billed as a "revolutionary fashion show" put on by Ophelia's Place here in Syracuse. While I'm not in general a fan of fashion shows, this really wasn't about fashion. It was about sending men, women, and children of all shapes and sizes down the runway with confidence. It was about redefining beauty to include many types of bodies and attitudes. It was about celebrating an aspect of the human condition that too often gives us cause for anxiety, obsession, and despair.

My favorite part of the event was the slide show at the beginning that encouraged the audience to stop the fat talk, stop body bashing. You know--the reflexive corporeal self-loathing we all (especially women) get into and express uncontrollably--to ourselves and to the world.

I love this message. Let's just stop--just say no. If you can't say something nice about your body, don't say anything at all. And don't be saying anything about other people's bodies. Because we are more than our bodies. We are powerful, strong, funny, loving, creative, inspiring, and beautiful.

I'm signing up for next year's show. Anyone want to join me?

* The terrible photo at the top of this post was taken by my laptop. I'm holding one of the purple chocolate butterflies that were given out at the event. It was delicious.

This is how myths about eating disorders are perpetuated

By work like this, from a psychologist at the University of Missouri.

If you've got a minute, hop over to the site, read the story, and leave a comment. I don't waste my time arguing with people online, but maybe Bardone-Cone can learn something from a different perspective.

Finally, some good news about fat

This blog post from Tara Parker-Pope discusses a study on the kinds of factors that affect how we visibly age. Make sure to look at the compelling slide show that goes along with it. It's a fascinating look at pairs of twins where one looks considerably older than the other. The study results suggest that smoking, sun exposure, depression, and weight loss all contribute to looking older.

Cool new study on anorexia

It seems clear that family-based treatment is an excellent way to go for adolescents who develop anorexia or bulimia. But what about adults? Now a new study out of University of North Carolina is looking for volunteers to test a related treatment that could help adults with eating disorders.

When a teen gets sick, parents are a crucial part of her/his recovery. This study looks at how spouses can be involved in recovery. It makes a lot of sense to me, because anorexia is anosognosic--people who have it either can't perceive that they're ill or, in the case of some adults, often can't "decide" to recover themselves. Having someone else take charge of recovery or at least be involved in it can make all the difference.

Kudos to Cindy Bulik and other UNC researchers for testing this one out. I look forward to hearing the results.

The world's funniest complaint letter

has got to be this one, written by a passenger on one of Virgin Air's India to England flights in December. Don't miss the photographs of food--that's the tangential link to the subject matter of this blog.

I haven't read anything food-related that's this funny since I read Wendy McClure's Candyboots site. If you haven't seen that, please go there right now. Don't read it while eating or at work.

Feb. 1 is Amazon Spike Day

So if you're planning to buy Feed Me! on Amazon, please do it tomorrow (the 1st). Thanks!

From the department of Gee, I wonder why

comes a gem of a press release that begins like this:

Yikes! 1 of 3 Canadian Women Battling Body Image

TORONTO, ON --- January 27, 2009 --- The mirror doesn’t lie. From muffin tops to thunder thighs, from junk in the trunk to flabby arms, Canadian women say they don’t like what they see.

Um, do you think there could be a connection here?

I get a lot of press releases like this, most of them hawking diets. Some, like this piece of work, pretend to promote positive body image even while undermining it. Note to PR flacks: My readers and I are smarter than you are. We can see the strings moving your arms and legs. And we know who benefits from garbage like this, and it isn't us. I won't name the ridiculous "expert" this press release is flogging except to say that s/he is not supporting positive body image.

Have you come across other oxymoronic examples? Send them my way.

Feed me, then review me

If you've read FEED ME!: WRITERS DISH ABOUT FOOD, EATING, BODY IMAGE, AND WEIGHT, I'd love to have you stop by Amazon and review it, so other people can see how great it is. I'm kidding about the greatness, but I would love to have a couple of reviews pop up on the Amazon site.

I appreciate it, y'all. And of course I hope you truly like the book.

Unspeakable

Eighteen-year-old Alicia Rae of Hampshire, England, was found dead in her bed by her mother yesterday. She'd been struggling with anorexia for two years and, apparently, lost the struggle. She was very nearly the same age as my daughter Kitty, who became ill with anorexia at 14 and who has been well now for three years.

It is unspeakable that Alicia Rae is dead at 18. It is unspeakable that her mother had to find her body. Unspeakable, but we have to speak about it. We have to say her name, Alicia Rae. We have to remember that anorexia kills, that in fact it has the highest mortality rate of any psychiatric disease, killing 20 percent of those who develop it.

We have to speak about what happens to the body and the brain when they are starved. We must talk of the unspeakable irony of a young woman like Alicia Rae, dying of malnutrition in the midst of plenty. We must speak of the hell she and her family went through, and of the churchyard where she's buried now, not far from her home, not far from the bedroom where her mother found her dead.

We must speak of these things and remember and tell them. We must do everything we can to make sure there are no more Alicia Raes. That means pushing for better treatments and spreading the word about new treatments that work. It means not hiding in the proverbial closet when eating disorders strike. It means standing up for our children and facing down the stigma of anorexia--the stigma that keeps us silent and despairing and alone.

In this season of new beginnings, we must talk of the unspeakable so that there will be hope.

And the winners are . . .

Tisa Agloro and Carrie Rigdon. Congrats!

Now, for those of you who did not win a copy but who plan to buy it on Amazon, I have a plea: Would you order it on our Amazon Spike Day, which is February 1st? That's this Sunday. No big deal if you just can't wait that long, or if you want to pick it up at your local independent bookseller (I'm all for supporting indies) or library. But if you are shopping Amazon and can wait, February 1st would be swell.

Tisa and Carrie, please email me your addresses and I'll get your books in the mail this week!

Thank you everyone! Please let me know what you think of the book. I love hearing from readers.

Win a copy of FEED ME!

UPDATE: We've got 149 entries. Woo-hoo! I'll be giving away 2 copies of the book!

Yep, I'm giving away a copy of Feed Me!: Writers Dish About Food, Eating, Weight, and Body Image, which I edited and which contains fabulous essays by writers like Caroline Leavitt, Joyce Maynard, Diana Abu-Jaber, Amity Gaige, Jenny Allen, Kate Harding, and many more. All you have to do to enter the drawing is send me your name and e-mail address before 1 p.m. on Monday, January 26. I will pick one lucky winner then.

To find out more about the book, click here and here. To read a digital galley of the intro and three essays, click here.

Good luck!

Why we need to change our attitudes

When my older daughter was ill with anorexia, she went through hell. The rest of the family did too--not the same kind of hell, surely, because after all, we could escape it for an hour or two while she could not. My younger daughter marched through hell along with us. She heard and saw anorexia with all its claws and teeth and terror, and like my husband and me, she came to loathe it.

We've talked quite a bit, she and I, in the years since, about eating disorders, about body image and weight. I've tried to model Health at Every Size for both my daughters. And yet my beautiful, lively, talented younger daughter, Lulu, is convinced that she's fat, and is upset about it.

I've tried reasoning with her: You're not fat; you're going through puberty. Your body needs a little extra flesh on it right now. And even if you were fat, so what? Fat is a descriptive word. We all have fat on our bodies.

And so on. I can practically see my words passing through her like ghosts sailing through a solid wall, making no mark and having no effect. Why should they, when we both know just how viciously society punishes those of us whose bodies are not naturally stick-thin. When the rest of the 8th-grade girls have straight hair and long, lean torsos, and my daughter has hair with a lot of wave and a naturally rounder shape.

The experiences of her sister's illness are now four years behind us. I'm glad they're fading for all of us. But I wish some of what we all saw and learned then could help my younger daughter now. I wish she could remember that there are a lot worse things than being round, that conformity comes with a terrible price, that food is nurturing and sustaining rather than the enemy.

She eats the same way she always has; you better believe I'm watching that closely. I worry, with dread in my heart, when what she thinks is going to inspire her to go on a diet for the first time, and whether she, too, will become anorexic. I worry and I watch and I wait. I wait for the day when I can say to her, "You're beautiful just the way you are," and she will believe it.

I hope I live long enough to see that day.

Change Is Good

Yes indeed.

But in the midst of such happy change, please remember to take a few deep breaths and practice loving what is. Because unlike our outgoing president, you are worthy of love and compassion, right now, as you are.

I want your ideas

Syracuse University, where I teach, has a program called Healthy Mondays. I know, I know; it's a bit silly, really, but the folks who organize Healthy Mondays mean well and may indeed do some good.

Now they're looking for ideas from faculty and students for small projects, and they're giving out small grants to help make those projects reality. I'd like to propose something about eating disorders. My first thought is to suggest a kind of "voices of eating disorders" oral history project, kind of like National Public Radio's wonderful Storycorps project.

I'd love to have your ideas. What, if anything, do you think is worth doing on a college campus?

Oprah and the "brown elephant in the room"

That, according to a recent New York Times article, is how Oprah Winfrey refers to the 40 pounds she's gained over the last year or two. The piece is titled "Her Bulge, His Book and Their Plan B," and focuses on her long-term relationship with the most important man in her life: Bob Greene, her personal trainer/diet guru.

It's an interesting piece and worth reading for those who are interested in the money side of the weight-loss biz. Greene has created several hugely profitable franchises from his work with Oprah--so profitable, in fact, that he no longer charges her for consulting. (I love that--the richest woman in the world doesn't have to pay!) The recent media attention to Oprah's weight gain has been a bonanza for Greene, a fact he readily admits.

There's much to shake your head at here, but it was this quote that really got me:

Ms. Winfrey has so far accepted all the blame for her lapse, not once suggesting the fault lies with Mr. Greene or his diet plan. "This has been a wake-up call for her to let me get back to doing my thing," Mr. Greene said.

Notice anything? Oprah takes blame for gaining weight. Not responsibility. Not ownership. But blame. As in, gaining weight is obviously a moral lapse that must be atoned for. Greene's "diet plan" is blameless, as is Greene himself. Not everyone agrees: At the end of the article, another trainer comments that "any time a client falls off the wagon, the fault lies with the trainer, because it is his or her job to formulate a plan that works for the client."

Here's a radical suggestion: Maybe the fault here lies neither with the stars nor with ourselves* but with the concept of dieting, a concept we know to be fundamentally flawed because 98 percent of dieters "fall off the wagon," as Oprah put it. Maybe the real problem is the frenzy of self-loathing we are so quick to fall into, which, I submit, does more to prevent us from "living our best life" than 5 "extra" pounds, or 30, or 80.

I've been there. Just ask my long-suffering husband, who's had to talk me off the ledge of self-hatred many times. One thing I know for sure: Self-acceptance feels a hell of a lot better than self-loathing. It's not easy to pull off in this culture, whether you're fat or thin. But it's worth the effort. Really.


* I can never resist a Shakespeare paraphrase or pun.

Tell President-elect Obama how you feel

Here's a chance to contribute to the next administration's health care agenda: Take 10 minutes to go to this site and post about an issue you care about. Mental health parity? Health at Every Size? More funding for eating disorders research? Whatever's near and dear to your heart, tell the change team. Today. Really. Because how often do we get a chance like this?

Six-year-olds and eating disorders

This Canadian article, published last November, is one of the few I've seen anywhere that overtly links comments and teasing about weight with eating disorders. A significant percentage of teens with eating disorders are overweight at some point. As this piece points out, other people's responses to their weight can start them spiraling down into the hell of an eating disorder.

"Research shows that when girls are teased about their size and their shape, they stop eating," says Mary Kay Lucier of the Bulimia Anorexia Nervosa Association (BANA).

Notice that she did not say "when overweight girls are teased." That's the part that gets me. The act of teasing and making fun of a young girl's weight, even if it's "all in fun" (a phrase I loathe), can be enough to trigger self-starvation in some kids.

Lucier went on to say, "We've had 25 seven-year-olds in the past year come in in a state of acute starvation." I can imagine all too well what lies ahead of some of these girls. It's not pretty. Not at all.

BANA runs education programs, but its budget (like so many nonprofits') has recently been slashed. If you feel motivated to give away a little money in a good cause, download a donor form here.

Maybe the best thing all of us can do is teach our children that just as it's not OK to touch someone who doesn't want to be touched, it's also not OK to comment on anyone else's body--positively or negatively. We have better things to talk about.

Parent support group meeting in Madison, WI

UPDATE: This meeting has been postponed due to weather. It will now be held Tuesday, 1/20, at 7 pm at Starbucks.

The monthly Maudsley parents support group meeting in Madison will take place this Wednesday, January 14th, at Starbuck's, 3515 University Avenue, beginning at 7 p.m.

This is a fabulous get-together of parents who are in various stages of family-based treatment and who cheer each other on, help each other problem-solve, and support each other through one of the toughest experiences a parent will ever go through. If you're helping a child through anorexia or bulimia with FBT, you might feel like you don't have time for something like this. But try to find the time--it'll help keep you going through the tough moments. And as we all know, there are plenty of those.

For information, contact Denise Reimer, reimer1@charter.net.

Obesity problems--true and faux

An anonymous reader posed a question to me on another thread, which I thought deserved its own thread. He or she wrote:

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

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

I'm not an epidemiologist; I haven't done any studies on this question. I've read extensively, I've thought about it, I've talked to people. I'll tell you what I think, personally, and then I'd like to hear from other readers who may know more than me.

What I've read suggests that there is no obesity explosion in this country. That in general Americans are a little heavier than they were, say, 50 years ago. They are also a little taller. Some of what I've read suggests that these two go hand in hand. I know that there was a surge in obesity statistics about 10 years ago, when BMI cutoffs were changed overnight. People who went to sleep merely overweight woke up obese, and an alarming new statistic was born.

I've read research suggesting that weights went up in the late 1980s, after several years of the low-fat craze. Which brings me to the point here: While I don't think we can say with any certainty that people are fatter now and/or why that might be, what we do know is that we can't make them thinner. So let's set assume for a moment that yes, people are fatter now. Let's take it a step further and proclaim that this rise in weight is a Serious Health Problem (and I'm not saying it is; as others have pointed out very well, fat is not equivalent to poor health, and thin does not correlate good health).

Here's the thing: We can't change what people weigh. Some people lose weight for a short time by dieting. But 98 percent of them gain it back, and then some.

So diets don't work for adults. They don't work for children, either. School interventions are notoriously ineffective when it comes to making kids thinner.

Now let's go back to that assumption, that weight is a serious health problem. There is little to no evidence of this. There is a correlation between obesity and diabetes, but it's a correlation, not cause and effect. We don't know that obesity causes diabetes; maybe whatever malfunctioning metabolic shift causes diabetes actually causes obesity. In which case, trying to "cure" obesity would be like trying to "cure" OCD by, I don't know, strapping someone's hands to their sides so they can't obsessively wash them. It would be treating the symptom rather than the cause.

When it comes to other measures of health, the statistics don't bear out the notion that obesity is a serious health issue. In fact, Katherine Flegal's now-famous mortality study points to modest advantages to being "overweight," especially as people age.

So in answer to your question, Anonymous, no, I don't know that obesity is a serious health problem in the U.S., and neither do you, or anyone else, for that matter. We don't have enough information; we don't even really understand the information we've got. Losing weight sometimes raises people's risk of dying from cardiac disease, in fact. We just don't know.

While we don't really understand all the implications of weight, we do know that fitness is good. Eating a varied diet that includes (but isn't necessarily limited to) fresh fruits and veggies is good. Exercising (but not to the point of obsession) is good. Feeling good about yourself is good (and feeling bad about yourself is bad for you).

So until I know more, really know more, I'm going to stick to my guns on this one. Eat well. Live well. Move your body. And, most important, love yourself as you are right now. Not 20 pounds from now but today, this minute. Self-loathing--the kind that is a natural consequence of the current anti-obesity hysteria--is far worse for people than extra pounds. As far as we know.

The Maudsley Institute

It's not really called that, but that's how I think of the new training program for Maudsley therapists, organized and run by Drs. Daniel le Grange and James Lock, co-authors of Help Your Teenager Beat an Eating Disorder. Its official name is the Training institute for Child and Adolescent Eating Disorders, and it aims to do something incredibly important: train therapists to do true family-based treatment.

Right now, many families in the U.S. who want to use family-based treatment to help their children recover from eating disorders face the unhappy choice of trying to go it alone, drive many hours to see a Maudsley therapist, or go with a different treatment. FBT is hard--the hardest thing most families will ever do. They need support. But at the moment, there just aren't enough true Maudsley providers to go around.

Maybe more important, families have no way to tell the faux Maudsley providers from those who truly practice and believe in FBT. There's a surprising number of therapists out there who say they practice Maudsley but who've given it their own unfortunate spin, like this one. And there are outpatient and inpatient programs who claim the same. Too often, what they're doing is NOT true FBT.

Lock and le Grange's new institute will put the seal of approval, as it were, on professionals who not only train with them but actually practice true FBT. This is good for everyone: Providers will get more training from the folks who know the treatment best, and families will have a measure by which to judge quality and competence of potential therapists. It's win-win.

The first training will be held February 27-28 in Palo Alto, California. It will take some time to "graduate" the first group of Maudsley therapists. Personally, I can't wait. Thanks to Drs. le Grange and Lock for doing this.

What do YOU do?

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

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

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

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

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

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

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

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

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

OT: Clearing the air on Kawasaki Disease

My heart goes out to John Travolta and his family for the loss of their 16-year-old son, Jett. What a devastating nightmare to lose a child. Any parent who's faced a child's mortality can empathize, I'm sure.

The Travolta family blames Jett's childhood bout with Kawasaki disease. We won't know for sure what happened until the autopsy is complete. But I'd like to clear up a few misconceptions about KD, as it's called, in the meantime

Kawasaki disease is a full-body vasculitis, meaning that blood vessels all over the body become inflamed. That's why the whites of the eyes turn red, along with the the soles of the feet and palms of the hands and the tongue. The heart, of course, is vascular, and it, too, becomes inflamed and can suffer permanent damage. KD affects mainly babies and toddlers of Japanese descent, and is often not diagnosed quickly. Children can indeed wind up with scarred and damaged hearts.

My younger daughter, Lulu, had KD when she was 8 years old. Luckily, a pediatrician recognized and diagnosed it promptly. Lulu spent 5 days in the hospital on intravenous gamma globulin and months convalescing at home. Today, at 13, her heart is fine.

No one knows what causes KD--and believe me, people have speculated galore. The Travoltas have been convinced for years that Jett's KD was caused by carpet cleaners. That's one of the theories that's circulated about it. I don't buy it, partly because hey, we never clean our carpets. KD is statistically more common in the winter and early spring (Lulu came down with it in January); maybe there's a correlation because people clean their carpets more in winter. I wrote a piece on KD for the New York Times and talked to all the leading researchers on it. They don't buy the carpet cleaners theory, either. It's more likely to be related to Staphylococcus aureus (Staph A) or toxic shock syndrome.

There is absolutely no evidence that KD causes autism. Repeat: KD does not, to the best of our knowledge, cause autism.

Of course there's a lot we don't know. We don't know that Jett Travolta was autistic, and frankly, it's none of our business. But we do know that kids who have had KD do not typically wind up with seizure disorders or autism.

I'm thinking of the Travolta family in their grief and loss, and hoping that Jett's death doesn't add to the misconceptions around Kawasaki disease. Maybe this well-publicized incident will inspire some researchers to get on the stick. There's been very little research done on KD. How about it?

Support Project Feed Me

One aspect of food and eating that I rarely write about is the fact that many people in this country and elsewhere go hungry because they're poor. Now an enterprising group of Syracuse University freshmen is trying to do something about that.

Project Feed Me is designed to not just feed the hungry but to inspire young people to get involved with community projects. The group's founder, Patrick J. Alvarez of New York City, has organized turkey dinners in Harlem, banquets, and basketball tournaments. Now the group is looking for the next level of support, including corporate sponsors and partners, volunteers, and donations.

You can do something to help right now with just a click of your mouse. The group is in the running for a grant from Best Buy.All you have to do to help it win one is click here every day and vote for Project Feed Me. You'll also find out about some of the other cool projects up for grants, and since you have to vote for 2 every day, you'll have a chance to support some other groups as well.

My metaphorical hat's off to Mr. Alvarez and the rest of the PFM group, for doing more than sitting around talking about it. They're walking the walk. Give them a hand, won't you?

Looking your best: One writer's (tongue in cheek) advice for dealing with the "obesity epidemic"

Pieces like this are just part of the reason I love the New Yorker magazine. Much better than the cartoons, IMO.

Enjoy, and happy new year!


Thanks to Caylin for the link!

Join a study, help yourself and others

In the spirit of the new year, here's a list of ongoing treatment studies looking for subjects. Joining a study is one way to not only contribute to the still-infant science of eating disorders treatment, but also get excellent treatment for yourself and those you love--for free.

May 2009 be a year when eating is a pleasure and not a terror or trouble to all of you.


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.

Maryland - Bulimia Research Study: The Johns Hopkins Eating Disorders Program is seeking women 18-40 years old with bulimia nervosa interested in a research study funded by the Klarman Family Foundation. The study includes a health assessment, blood testing and pictures of the brain taken using a medical scanner. Eligible women will be paid up to $400 for their participation and will be offered 6 weeks of outpatient treatment. Call 410-955-3863 or see this site for more information.

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, NP 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 this site.

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.

North Carolina: The University of North Carolina's Eating Disorders Program announces a new clinical psychotherapy trial for bulimia nervosa. This study is comparing two different ways to deliver cognitive-behavioral therapy. (CBT) which is the treatment of choice for bulimia. Patients will be randomized (like a flip of a coin) to either face to face group CBT or internet-delivered CBT with a therapist-moderated chat group. There is no cost for participating in this trial. Eligibility Requirements: Male or Female, at least 18 years old, have a home computer with Internet access. Contact the Research Coordinator at 919-966-2882 or cbt4bn@unc.edu for more information.