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.

When were you born?

I stumbled on this via Laura over at Eating With Your Anorexic, and expected it to be kinda silly.

To my surprise, some of it holds true for our family:

I have panic disorder; I was born in October.
My husband has dyslexia; he was born in July.
My younger daughter also has panic disorder, but she was born in July.
My older daughter had anorexia; she was born in February.

I have no idea what it means, though these people have attempted to make sense of it. Is this soothsayer science or is there some truth in here?

It's interesting to think about, either way.

18 minutes that will change your life

That's what watching this video will do: change your life. It will change forever the way you imagine your brain. The way you understand your relationship to the world, physiologically, psychologically, and spiritually. Watching this was one of the most profound experiences I've ever had.

Watch it, and tell me how it affected you.

Score one for FA

As reader Annie McPhee points out, the appalling article on the "Being Girl" website (that's not even grammatical, folks!) conflating the war on terror and emotional eating has, thank the Goddess, been removed.

It's a start. But this site still has plenty of egregious content up, including this, this, and this.

Come on, people! You can't write a piece bemoaning the pressure on girls to be thin and wind it up with these words of non-wisdom:

There's no need to eliminate any food you enjoy from your diet. Just learn to make trade offs and balance unhealthy foods with healthy ones. And keep on the move. The safest and most appropriate obesity prevention strategy is to get rid of those "automobile feet" and exercise.

This site can't decide what its prime directive is. Oh, wait, yes it can: to sell "feminine hygiene" products.

All this cognitive dissonance is giving me the urge to go eat some unhealthy foods. Pie, anyone?

Dangerous words

I know of people who have recovered from eating disorders at Remuda Ranch (don't you love the name? don't forget your 10-gallon hat, little lady). But I am no fan of places like Remuda and Renfrew, big profit-making chains of residential treatment programs. They're a real mishmosh of treatments, their long-terms statistics are crappy, and, most of all, they imply through their very existence that families are a liability, not an asset, when it comes to recovering from an eating disorder.

Now they've pretty much come out and said so.

And I'm glad. You know why? Because now at least it's out on the table. I'd much rather have someone say it out loud--Families cause eating disorders--than get the knowing looks, the condescending body language, the unspoken judgment.

The stigma of eating disorders is vile and deep. It kills people as surely as starvation does.

The first step to fighting stigma? Get it out into the open. See it for what it is. Name it. Yank it out of the closet of politeness and into the hard light of reality.

And then stomp the shit out of it.

Oh for fuck's sake

I was already feeling testy when Kate Harding forwarded me a link to this abomination.

Titled "What Does the War Have to Do With Your Weight?," it's an absurd conflation of talk about terrorism and overeating. The worst part is that it's aimed at adolescent girls.

Here's a wee sample from the opening paragraph:

Are you one of the millions of teens who overeat when they are under stress? If you are, we've got some good news and some bad news. The bad news is that rarely in history has there been a more turbulent time. Since 9/11, it seems as if the problems of the world are growing larger and scarier... and looming closer than ever before. The good news is that you are not alone. Fifteen percent of Americans confessed that after the towers fell, they turned to comfort foods while another 14% reported eating more sweets. Two months after the terrorist attacks, one in ten Americans had gained weight. Anyone versed in psychology is familiar with the relationship between mood and food.

If this was a writing assignment I'd give it a big red F for conflating disparate ideas that have nothing to do with each other (9/11, eating), for catastrophizing and distortion of facts (if 15% "turned to comfort foods," that means 85% didn't--a much more significant number), for piss-poor organization (the "good news, bad news" conceit is grossly inappropriate), and for failure to show cause and effect (even if 1 in 10 Americans gained weight after 9/11, it does not prove the central point here). We'll throw in a bonus point for that last line, which does a better job of rhyming than of proving any kind of point.

Of course, the next line is pretty over the top, too:

Whether it's the war with Iraq, hard decisions abut college, or troubles with friends, some of us use food to provide the good feelings we're missing.

I don't know about you, but I often reach for the Oreos when I think of the Iraq War. Doritos, on the other hand, are my comfort food of choice when I think of Vietnam. The Korean War takes me straight to the freezer for some Ben & Jerry's. World War II? Gotta be those Jello pudding cups!

It's more than just fodder for satire, though. The site goes on to suggest 9 ways for girls to improve their eating habits, including:

1. At the moment you grab for something to eat, tell yourself you can have it if you still want it but you have to wait 30 minutes. The craving may pass, you might get distracted, you might become wise enough in that half hour to find a more life affirming way of getting rid of that creepy stress.

2. Write down everything you eat. Icky, we know, but we also know there's no better substitute (except looking at yourself in the mirror naked), that's better than tracking what goes into your mouth to get you into the habit of thinking before you eat.

I remember strategies like these from Weight Watchers. And from my own daughter's spiral into anorexia.

One of the worst parts of the site (created by Proctor & Gamble) is an unmoderated discussion for girls. Some of the comments on the site made me want to weep.

To tell P&G what you think of its site, click here. (You have to give a birthday to send feedback; I always type in a fake birth date.)

I've been reviewed by someone named Calamity

And the news was pretty good. :-)

Off-topic but irresistible

It's good to know that leaving Wisconsin for New York will not reduce my opportunities for being cynical about our Fearless Leaders.

Everyone knows who's doing what here. But these darn midwesterners don't blab it to the New York Times. I guess.

Distracted

Apologies to regular readers for not posting much the last week or two. I've been in negotiations for a new job, and I'm delighted to say that beginning this fall I will be an assistant professor in magazine journalism at the Newhouse School of Journalism at Syracuse University.

Big changes for me and the family, including a move back east from the wilds of Wisconsin.

My head should be back in the blogworld pretty soon. :-)

Progress on parity

According to a press release from the Eating Disorders Coalition, eating disorders "were front and center" in the debate that ended with the House passing its own version of a mental health parity bill, 268 to 148. The House version is much better than the Senate version passed last year, but it's unlikely to be the one passed in the end.

Still, the fact that we're even talking about having a mental health parity bill in this country just blows my mind. It's about goddamn time.

I love this quote from EDC executive director Marc Lerro: “We made our points so often that members of Congress started making our points for us. In committee meetings, Republicans and Democrats alike described how parity could affect people with eating disorders.”

Now that's activism at work.

Another good quote comes from David Wellstone, son of the late Senator Paul Wellstone of Minnesota. He felt the Senate bill didn't go far enough and refused to let it be named after his father, saying, “My dad always believed that you can’t leave people out." The Senate version would not protect people with eating disorders to the same degree as the House version.

But it's a start.

SOTD: Anti-depressants don't work?

Today's Study of the Day comes to us courtesy of the U.K.'s Hull University, where an analysis of 47 separate trials purportedly showed that most treatment with SSRIs is little better than a placebo.

Here's the paragraph that caught my eye:

The study has credibility because it has included data which drug companies had chosen not to publicise possibly because it was less favourable than they would like, and it suggests that millions are needlessly taking powerful and potentially dangerous drugs.

I don't know if this is true, but it's a hell of a story if it is. Would it surprise anyone to know that drug companies withhold information?

On the other hand, I know people whose lives have been saved, literally, by meds for depression. I would hate to see a wholesale rush to drop them.

What do you think?

What will it take to change the system?

This is a question I ask myself a lot. What will it take to create a health care system that truly cares for all people, sick and well, young and old, healthy and not?

It seems self-evident to me what we need. But my eyes were opened a bit about the way the rest of the world sees it when I sat in on a class at the Center for Patient Partnerships here in Madison.

The guest speaker was a woman who's worked in health care policy at the national and state levels. She explained that in order to change policy, there must first be some shared perception of a problem. And she pointed out that for those who have great health care (say, our elected officials), there is no perception of a problem and so no incentive to work toward change.

Which makes it all the more clear to me that we need to raise our voices around inequities in the health care system. Add your story here if it's appropriate. If it's not, please send it to me. I think maybe we need another blog where we can collect stories of the inequities of the health care system--and then send them to every member of Congress as often as possible.

Make a call for mental health parity

Last week I learned, to my shock and horror, that because my daughter had anorexia, we cannot get health insurance, except through a large group plan (i.e., through an employer). We can't become freelancers and buy our own health insurance because, as our agent said, "You'll never pass underwriting."

What we need in this country is real true health care reform, not some bullshit foisted on us by the greedy health insurance companies. And I hope to God I live to see the day it finally happens. In the meantime, we can do something now by helping to pass a federal mental health parity law. The U.S. Senate has already passed its version; now the House of Representatives is getting ready to debate its version.

Please take a few minutes to call your Representative and advocate for passage of H.R. 1424, coming up for debate this Wednesday. The Eating Disorders Coalition--one of the most effective advocacy groups in the eating disorders world--suggests saying something like this:

I am a constituent of Representative ______ and a supporter of the Eating Disorders Coalition. I am calling to ask that the Representative vote for H.R. 1424, the Paul Wellstone Mental Health & Addiction Equity Act. Parity is a fair and affordable solution to insurance discrimination against people with eating disorders and other mental disorders. It will save lives and families.

But you can say whatever you want. Just make the call. Please. In this era of pressure politics it really makes a difference for the folks in Washington to hear from the little people.

The number to call is 866-727-4894.

(Not sure who your Representative is? Go to this site, click on the little hand on the upper left hand side of the page, and enter your zip code to find out.)

All of us who have found ourselves in DSM at one time or another thank you kindly.

What, if anything, can you say?

That's the question raised by Kate in the previous thread:

If we think intervening is good, maybe even if the person we see struggling with eating is a stranger, how are we supposed to approach it?

She's wondering about what to say or do when you see someone who is obviously struggling with anorexia, whether it's a stranger, an acquaintance, or a friend.

I can't imagine anything anyone could have said to my daughter when she did have it that would have made a difference. But she was 14 when she was ill. Is it different if you're older?

I would really like to hear from those of you who have struggled with anorexia. Was there anything that anyone said that made a difference to you? What was it? What advice would you give someone like Kate?

Anorexia: a portrait

WARNING: THIS POST MAY BE TRIGGERING.




You’re standing in a bakery. Not just any bakery—-let's say it's the best bakery in Paris. It’s warm, and the room is full of so many wonderful smells: cinnamon rolls, sourdough bread, pain au chocolate. Flaky Napoleons decorated with real gold leaf, the chocolate custard oozing from between flaky layers. Gateau, petits fours, elephant ears, all of them buttery and sweet and warm.

And you’re hungry. Not just a little hungry, not just wanting to eat. You’re starving. Your hunger is a hurricane blowing through you like a thousand fists, battering your insides. It’s a tiger clawing you, its claws sharpening on your insides. As you stand in front of the glass cases filled with beautiful pastries and cakes and breads, the tiger swipes at you again and again. Your stomach clenches and contracts. You swallow again and again.

More than anything you want what’s in those glass cases. You want to sink your teeth into one of those pastries, let almond filling ooze from the corners of your mouth, lick raspberry jam from your lips. You want to bite into an éclair, taste the rich custard, hold the chocolate against your tongue until it fills your mouth with sweetness. You know just how good everything would taste because you’ve been dreaming about it, night and day, for months. Other people come in and out of the bakery, buying white paper bags full of warm cakes. Other people reach into those bags, break off a piece of croissant, pop it into their mouths. But not you. Never you.

Because you are not allowed to eat. Though your stomach grinds against your backbone and your cheeks are hollow, though that familiar wind howls inside you all day long, you cannot eat. When you do, when you manage half of a fat-free yogurt, a pretzel, two grapes, the voice in your head starts up again. It hisses in your ear—how weak you are, how stupid and lazy and gluttonous. It shouts at you all day long: You’re a fat pig. You’re disgusting. You don’t deserve to eat. You don’t deserve to live. You don’t remember when that voice began. You can’t remember a time when it wasn’t inside you, always watching, making you suffer. The voice takes you inside your worst nightmare, to the scariest place you’ve ever been, a place you’d do anything to stay out of. So you don’t eat, even though food is all you think about, all that matters. Even though all day long, wherever you are—doing homework, sitting with friends, trying to sleep—part of you is standing in this bakery, watching, smelling, longing to eat, paralyzed with fear.

And you can’t leave the bakery, either. You have to stand here, breathing in those buttery, delicious smells, the voice growling softly in your ear. You have to stand here, longing for the pastries, terrified and alone. You have to stand in this bakery, shivering now, getting colder and colder and more alone while the rest of the world goes on, full of light and laughter and good things to eat.

You wish someone else could sweep into the bakery, cry, “Here you are!,” hand you a warm roll straight from the oven, and protect you while you take that first bite, the buttery taste of relief. You wish there was someone, anyone, who could shout down the voice, who could keep you safe. But there isn’t. There will be no rolls for you, no pastries, no feeling of relief and safety. There’s only the voice and its torments, and you, more alone than you’ve ever been. You, growing smaller and thinner and frailer. You can't bear the suffering. You want to die.

This is what it feels like to have anorexia.

Tapeworms, anyone?

You couldn't make this stuff up if you tried.

**Link from Asylum, courtesy of Abigail Saguy.

A little exercise for National Eeating Disorders Awareness Week

As I was reading this article on the "global obesity epidemic," I couldn't help thinking that it was in fact a blueprint for creating an eating disorder.

Let's take a closer look.

Wherever we read the words weight gain let's substitute the words weight loss. Wherever we read the word obesity, let's substitute the word anorexia. Instead of weight maintenance, let's go with weight loss. For prevent we'll say cause. For less, more.

Now let's look at the section of the article that talks about strategies for weight maintenance--I mean weight loss.

[The researcher] will argue that small daily changes, say using the stairs, are enough to cause incremental weight loss that can lead to anorexia. [The researcher], however, will make the case that much larger life-style changes - say exercising 60 to 90 minutes a day - are needed to cause weight loss.

"Our data from the National Weight Control Registry suggests strategies associated with successful weight loss include high levels of physical activity and conscious control of eating habits," said [the researcher]. "Dieters who remain diligent about diet and exercise are much more likely to gain weight back."

Examples of conscious control include frequent weighing, following a consistent dietary regimen across the weekdays and weekends, and taking fast action if small weight gains are observed. . . .



Actually you don't even have to change a lot of the language here, because the basic idea in maintaining weight loss is the same in inspiring weight loss. You've got to make changes in your life--in other words, you've got to behave in eating-disordered ways--in order to lose weight.

Frequent weighing, rigid eating behaviors, obsessive attention to dietary details. Yup. Sounds like an eating disorder to me.

And since this is, after all, a week when we are supposed to become more aware of eating disorders, I encourage you to go out and eat something and then not write it down. Have a second helping. Don't weigh yourself. Eat what you feel like. Stop when you're done.

In other words, eat normally--if we can even remember what that means.

A health insurer gets its comeuppance

in this story, sent by a friend, about a judge who ordered punitive damages for an insurance company that dropped a breast cancer patient in the middle of chemotherapy.

I'm particularly obsessed with health insurance stories right now, having just heard that our family would not make it through medical underwriting now because our daughter had anorexia. This story has nothing to do with food, eating, or eating disorders, but it's just so damn gratifying to see a health insurance company get called on one of its many out-and-out exploitative practices.

I'm always amazed at how self-serving these companies are--and how they get away with it. So yay! for the good guys. And a big thank you to judge Sam Cianchetti, who did the Right Thing and who I hope will be rewarded for his good judgment somewhere, sometime.

Now if we could just send the CEOs of companies like Health Net to jail for doing stuff like this, I'd be a happy girl.