Why I don't fast on Yom Kippur

Millions of Jews around the world are fasting today, in observance of Yom Kippur. From sundown last night to sundown this evening, they will drink and eat nothing, in honor of the most sacred day of the Jewish calendar: the day your fate is sealed in the book of life for the coming year.

I am not fasting this year, or next year, or any other year. Not because I'm too gluttonous to give up food and drink for 24 hours. Not because I think it's irrelevant.

I'm not fasting because of what it means to be to be hungry, to be fed, and to be strong.

Let me tell you a story: My first Yom Kippur fast happened the year I turned 13--an adult for the purposes of Jewish law. I wanted to fast. I wanted to behave like an adult. I wanted to look pale and weak, to feel my stomach cave in toward my spine, to do my duty and sacrifice for the sake of holiness.

(If this sounds like the rhetoric of anorexia, well, keep reading.)

I made it through the night, the next morning, the next afternoon. Through hours of services, singing, breast-beating, and sermons. I was strong. I was proud. I was adult.

I was also very, very hungry.

In our house then, food was a kind of emotional currency. Food could be love or punishment; withholding of food could constitute either extreme. My mother was always dieting, which means that we ate, but always with the sense that we weren't really supposed to. The less you ate the better. Appetite was a bodily function that made you weak, and gluttonous, and fat. Appetite was to be squelched at every opportunity.

By 5 o'clock that Yom Kippur afternoon, I felt like I would faint if I didn't eat something. Anything. I left services and went around back, to the synagogue's playground (it was also an elementary school). I sat on the swing, went down the slide in my fancy new dress, and dug idly in the sandbox.

And that's where I found it: a half-eaten Milky Way bar. Someone had taken a few bites and then tossed it, wrapper and all, into the sandbox. It was food. It was my favorite candy bar. It was covered in sand and looked better than any food ever had to me.

I peeled the wrapper and took a bite of the uneaten side. I took another, and another, and soon had eaten the whole thing, sand and all. I felt guilty and ashamed. I was weak. I was unworthy.

I was also, later that night, sick as a dog, throwing up the candy bar and the break-the-fast meal we ate a few hours later. Retching and miserable, I had plenty of time to connect the dots: I had sinned, and I was being punished. Violently. Virulently. Righteously.

Fast-forward 35 years or so, to a night when my daughter Kitty was lying in the ICU, dying from anorexia. She was dying because she would not, could not eat. It took every ounce of determination and grief my husband and I had to help her start down the road to recovery.

That's when I connected the new set of dots: Not eating could kill you. Being hungry held no virtue. In the ultimate appetite sweepstakes, being hungry was the booby prize. You thought it was the goal, but really it was the punishment.

There have been plenty of times in my life since that Yom Kippur long ago when I have been hungry. But in the intervening years I've learned to honor my appetites--for food, for love, for compassion, for connection. This learning has changed my life.

And that's why I'll never again deliberately starve myself, for a day or for a month. There's far more virtue in learning to live with appetite and hunger than in shutting it down.

"You look great! Have you lost weight?"

I went "home" for the weekend last week--back to Madison, where I lived for 16 years. It was great to see old friends, neighbors, acquaintances, etc., and very emotional, too. It takes time, lots of time, to forge friendships. This year is rather a lonely year in Syracuse.

It was great to see those friends, but I really wish so many of them hadn't commented on my weight. The consensus seemed to be that I was looking better than usual so I must have lost weight. This conflation really, really bugs me. Why is a weight loss always associated with looking good?

I went to the doctor today and got on the scale for the first time in probably 6 months. Yes, I have lost a couple of pounds, but not, as one friend suggested, "a ton of weight!" For someone my size--five foot one and a little, 161 pounds--a couple of pounds makes little visible difference.

"You look good because you're happy," my husband pointed out. That's right. I'm engaged and invigorated by my new work and by the challenges and curiosities of making a home in a new place, and it shows.

I look forward to a day when looking good and losing weight are two separate and distinct ideas. And when we think twice before mentioning them in the same breath.

Celebrity weight watchers

I won't be the first person to rant about the intense media attention we pay to celebrities' weights, and I won't be the last. But this little video really bugged me almost as much as the scene in the Sex and the City movie where Samantha (Kim Cattrall) has gained 10 pounds, and the rest of the characters act like she should put on a burqa and have her jaws wired shut.

In this case, the video suggests that actress Demi Moore has gained 15 pounds. "Is there more of Demi to love?" croons the voiceover. The tone of voice makes it clear that this would not be a good thing.

I pity any woman (or man, for that matter) who is subjected to this kind of scrutiny. It feels to me like a form of externalized self-loathing--things we wouldn't dream of saying to or about an ordinary person may be said about a celeb because, hey, she's fair game.

We learn, from the culture that produces such relentless trash, to say these things to ourselves, about ourselves. Videos like this feed the nasty little voice that lives in our heads, telling us you're fat, you're ugly, you're old, you're worthless. For some of us, this voice can become deafening. For some, it stays relatively quiet.

But you know what? Even a whisper of this is too much.

Harvard bucks the mainstream on "nutrition information"

Last year, if you ate at a Harvard dining hall, you were confronted by a large sign listing the calorie, fat, protein, etc. content of everything you ate.

This year the signs are gone, thanks to a group of parents who protested them.

"The feeling was that for people who have eating disorders or who struggle with issues around the literal value of food, the emphasis on nutrition information does not always lead people to eat in a healthy manner," said Harvard dining hall spokeswoman Crista Martin.

It's naive of anyone to think that an "emphasis on nutrition information" will lead to "healthier" eating decisions. Most of us can't help but be aware of fat grams, calories, etc. in the food we eat (or don't eat), and the effect is hardly salutory.

I practice intuitive eating most of the time. I gave up dieting years ago. I parented a child through anorexia. But when I'm faced with those "nutrition information" signs, I immediately feel that whatever I'm eating, or about to eat, is too much. I immediately slip back into a mindset of any calories are too many.

It's like the story about the old miser and his horse. Each day the miser fed his horse a little less, until finally the horse died of starvation. The miser's comment: "Just when I was training him to need no food at all!"

Those calorie count listings make me feel as though the goal is to eat as little as possible--ideally, nothing. They immediately trigger fear, anxiety, and the restricting mindset.

Luckily I am too ornery to stay in that mindset for long. But is it really a surprise that for students at Harvard, one of the most competitive schools on the planet, signs listing calorie counts of everything served in the dining halls might be a bad idea? That a vulnerable population (driven, intensely competitive Harvard students) might be triggered by these reminders of "healthy eating"?

I don't think so.

I only wish the rest of the world would follow Harvard's lead on this one.

Free bulimia treatment

A research team at University of North Carolina, led by the fabulous Cindy Bulik, is looking for people with bulimia to take part in a pioneering study on treating this disease.

The study takes place at two sites: UNC, in Chapel Hill, and University of Pittsburgh. But you may not have to live in either of those places to enroll in the study, because half the study participants will be randomized to what researchers are calling CBT4BN, a web-based treatment involving weekly on-line chats with therapists and other distance elements.

The idea is to get treatment to people who may not have access to a therapist trained in cognitive behavioral therapy (CBT), which is currently the gold standard of treatment for adults with bulimia. The Maudsley approach has shown great promise for adolescents with bulimia.

Eating disorders are terrible, life-sucking diseases, and their treatment is still largely mysterious. Studies like this one are literally a lifeline to people struggling with EDs. So thank you Cindy, and the rest of the team, for doing this crucial work. Those of us who have seen people we love come suffer with an ED are very grateful.

Fighting weight discrimination, one doctor at a time

If you've ever had the experience of going to a doctor for an earache and being lectured on your weight--or even if you haven't had that experience but dread it--there's hope for America's doctors. Yale University's Rudd Center has created an online course to help sensitize docs to weight discrimination in themselves and in the health-care system. According to a spokesperson, the course is also designed to help docs develop strategies to serve their patients better--always a good thing.

Doctors get 1 credit of continuing ed for doing the course, and their patients get a doctor who's at least been exposed to the notion of fat acceptance and questioning the status quo on weight.

I looked at the first few frames of the course and have to say it looks pretty cool. Check it out. Better yet, get your doctor to check it out.

Fighting Stigma with Science

This video is required watching for anyone with an interest in eating disorders. Cynthia Bulik is one of the leading researchers in the field, and this interview, done by Jane Cawley, co-chair of Maudsley Parents, is compelling and important. Take a look.


Fighting Stigma with Science from Jane Cawley on Vimeo.

Eat to enjoy, not to lose weight

This article in the New York Times may seem a bit redundant to some, but I'm encouraged to see it in the venerable Gray Lady herself. It saddens me a bit that the notion of eating for pleasure rather than weight loss is such a novelty, but there it is. At least it's out there.

David Foster Wallace, 1962-2008

My closest encounter with the writer David Foster Wallace, who committed suicide last week, came when I was working as an assistant in a small literary agency. One of my jobs was to read the slush pile, the manuscripts sent in cold by hopeful writers looking for an an agent. One of the manuscripts that came across my desk was a draft of what later became Wallace's first published book, The Broom of the System. It was brilliant, entertaining, dazzling, and I wanted to take Wallace on as a client. My boss said no. "He'll never be a commercial writer," he said scornfully, and that was that.

He was wrong, of course, about that and many other things. Wallace went on to become not only critically acclaimed but to achieve some measure of commercial success. He was an original, one-of-a-kind, a writer of immense talent and heart. From the oustide, his life looked golden in every way.

He was also, we know now, severely depressed for much of his life. His struggle with depression came to an end last week when he committed suicide. And therein lies my point. It is impossible to know, from the outside, what anyone else's interior life is really like. That works both ways: The perfect-looking life may be a living hell, and the seemingly diminished life may be rich and full in ways outsiders can't imagine.

I bring this up not only because I'm mourning a writer of grace and heart; I bring it up in this blog because eating disorders, like depression, often present a golden exterior. The life of someone with an ED can look wonderful, perfect, fulfilling to an observer. Yet the person who struggles, every day, every minute, with anorexia or bulimia or ED-NOS, may be smiling through torment.

When I read about Wallace's death, I couldn't help thinking about how many people with anorexia wind up committing suicide as well. And I mourn them too--the lives that could have, should have gone a different way.

I mourn the misfire of chemicals in the brain that causes severe depression, anxiety, eating disorders. And I look forward to the day when we will know more and be able to help more.

In the meantime, go out and read one of Wallace's works, and remember this talented and tormented man.

No evidence-based treatment for anorexia?

According to this study, which is an overview of 40 years of eating disorders treatments, there are still no evidence-based treatments for anorexia nervosa. "A specific form of family therapy (based on the Maudsley model) appears promising," write the study's authors.

Appears promising? Actually, FBT, or the Maudsley approach, has been shown to be successful (85 to 90 percent long-term recovery rates) for treating both anorexia and bulimia. In the last 10 years there have been several good studies on FBT, including this one, this one, and this one.

And yet some of the top researchers in the field are still saying that there is no evidence-based treatment for anorexia, and that the Maudsley approach "appears promising." Which is rather like saying that there appears to be a link between smoking and lung cancer.

After 40 years with no other good treatments, you'd think researchers would jump on this one. So why the damning with faint praise?

Come on, you guys. You're the ones who can get the word out to parents best. You have a moral obligation to spread the word about FBT--the ONLY evidence-based treatment we've got at the moment for treating anorexia. I'll be thrilled if we turn up more treatments that are effective. In the meantime, though, let's use what we've got.

Take a survey, help eating-related research

The invitation below comes from a graduate student at the University of Maryland. Please correspond directly with her if you have questions. Take the survey and help add to what we know about eating.

--HB

TO ALL WHO WROTE IN: The link has been fixed now. Thanks for letting me know!

TAKE A SURVEY

Do you love food? Can you often “out-eat” most of your friends? If the answer to either of these questions is “yes,” you may be a great candidate to take my survey.

My name is Colleen Schreyer, and I am a grad student at the University of Maryland, Baltimore County. I am doing my master’s thesis on individuals who are able to eat a lot of food, and genuinely enjoy eating. I am also looking at individuals who are able to eat a lot of food, and perhaps don’t feel so good about it. I have an online survey that takes approximately 30 minutes to complete. All participants are entered in a drawing to win an Apple Ipod. Your answers are completely confidential, and I have approval from my university to conduct this research. If you would be willing to check out the survey, please click on thIS link. All and any help is greatly appreciated. If you have any questions, please email me- colleen2@umbc.edu. Thanks so much for your time!

An open letter to all diet food peddlers

Due to the recent avalanche of PR-type emails to my inbox, I feel compelled to write this letter.

If you do PR for a diet-related product, please do not send me emails offering to send me samples and hoping I'll review it on my blog.

Don't send me perky emails about 100-calorie foods that will fill you up all day, packed full of unparalleled nutrients. (Really! Who dreams this crap up?) Don't think I'll shill for you. I won't. If I write about your diet product, rest assured I will tear it apart. That kind of publicity you really don't want.

This blog is NOT diet friendly. To paraphrase my late friend Mimi Orner, we are anti-diet, anti-anorexia, anti-bulimia, anti-healthy eating fascism, and anti-eating disorder here. I am not your friend. My readers are not your potential customers.

This blog is a diet-free zone. Go peddle your crap somewhere else.

Support group for parents: Madison, Wisconsin

The next meeting of the Madison, Wisconsin, parent support group will take place on Tuesday, Sept. 23, at 7:30 p.m. at Starbucks, 3515 University Avenue. This group is parent run and offers support, practical advice, encouragement, and hope for parents whose children are struggling with eating disorders, with a special emphasis on Family-Based Treatment (also known as the Maudsley approach).

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

And if you'd like me to post a parent support group in your area, please email me off the blog at hnbrown at tee dee ess dot net.

Naturally fat?

This comment, made in response to an earlier post, seems to epitomize so much of the anti-obesity attitude that I thought it deserved its own post:

Of course there's nothing wrong with being fat. I don't get why fat people get offended when we say that obesity is dangerous. We're not talking about people who are fat. We're talking about people who are dangerously obese. You remind me of the naturally skinny girls who get offended when people speak out against anorexia nervosa and complain, "Why does everyone hate skinny people? Wah!"

There is absolutely nothing wrong with being naturally fat or naturally skinny. But if someone is deathly thin or morbidly obese then it is a real problem.

So first of all, please tell us how to distinguish between "naturally fat" and "morbidly obese." What is "naturally fat"? Is it the-amount-of-fat-I would-have-had-if-I'd-never-gone-on-a-diet? Is it 5 pounds "overweight"? 20? 50? Is it the same for you as it is for me? Is it fat that comes from eating avocados and almonds as opposed to chocolate cake and ice cream? Who decides what constitutes natural fat vs. unnatural fat?

I'm fascinated by the semantics around this issue. Morbidly obese = morbidity = a death sentence if you're fat. When's the last time you heard anyone called "morbidly skinny"? And yet semi-starvation can certainly kill you.

Personally I don't know any "naturally skinny girls who get offended when people speak out against anorexia nervosa." Someone who is thin but not eating disordered typically wouldn't be offended by this. Someone who's eating disordered, either diagnosed or subclinically, might well be offended because the nature of anorexia is to be ego-syntonic. They identify the illness with themselves and will defend it to the death--their own. They can't help it; it's a symptom of the disease.

I hope my readers will weigh in (so to speak) on this one. I'd like to know what you think.

Fat-free picnic

My younger daughter and I just came from an all-school picnic at her new school. She's starting 8th grade on Monday. The picnic was massive--800 people milling around the school grounds on a humid, muggy night. It wasn't the kind of event where you meet and really get to talk to people, and that was OK.

What wasn't OK was the food. Oh, it tasted all right, but I noticed there was nary a speck of fat or sugar at the picnic. There were flame-grilled veggie burgers, grilled chicken breasts, and I believe some kind of hot dog (I don't eat meat, so I didn't notice). There was pasta salad in a vinaigrette that was all vinegar. There were grilled veggies, which were very tasty. There was a huge bowl of salad with an array of dressings, every one of which was fat-free. I asked one of the caterers if there was any salad dressing with oil in it, and she said, "Honey, they specifically told us to bring only fat-free dressings."

For dessert there were trays of watermelon, which happens to be the one fruit I dislike.

I just hope this isn't a sign of things to come.

Are you a woman in your 20s or 30s? Read this

This opinion piece is not on the topic of food or eating, but this is a crucial and compelling subject, and one that every woman (and man) in America today should read. Especially those of you who think feminism was what your parents and grandparents did, and you're the new post-feminist generation. :-) There is still work to be done, my friends.

Suffer the little children

The latest "SmartSummary" from our much-hated health insurer arrived in the mail yesterday. I'm sure one reason our premiums are so high is that they periodically generate an 8-page booklet for each member of the family, replete with all sorts of useless information.

The piece that really burned my boat was this page, which arrived only with my 8th-grader's package. Let's take a minute to deconstruct this noxious document, shall we?

First, take note of the underlying threatening tone of the introduction. In case you can't read the scan, here it is:

Before you go back to school, take a minute to think about how sitting in class means you'll need more time for physical activity outside of school to stay healthy. Use this Body Mass Index (BMI) to figure out if you're in a healthy weight range, then you can see how to burn more calories and eat healthier in a way that fits your lifestyle.

Ths little gem offends on a variety of criteria, starting with the grammatical and syntactical errors (comma splice, word repetition, and excess verbiage). It then moves on to emotinal blackmail. Sitting in class leads to not staying healthy, unless you add more physical activity. There's a not-so-implicit threat here: You've got to burn off every minute you spend sitting on your tush and studying, kids.

For a kid like my older daughter, who likes to play by the rules and do everything "right," this notion could be enough to trigger a lifelong eating disorder, not to mention a fear of school and studying. And who's to say that each kid isn't already plenty physically active? The summary assumes that kids aren't getting enough exercise. Maybe they are, maybe they aren't. But this piece of paper sure as hell doesn't know.

Moving down the page, notice the list titled "Burn the Calories." One of the most egregious ideas behind the whole "wellness" movement is the idea that you can quantify and generalize in this way. Whereas anyone with a whiff of education on the subject knows that this depends not only on the size and age of the person in question but on his/her particular metabolism. Yet this paper confidently announces that a half hour of soccer burns 238 calories. Bullshit.

The eating disorder triggers continue on the bottom left of the page, where my daughter is told that 1 small cheeseburger would take 29 minutes of jogging to "burn off." There's a lot wrong here, starting with the idea that every bite you take must be "burned off." That's like saying every gallon gas you put into your car must be used immediately. Then there's the implicit idea that the foods listed here--plain "donut" (sic), cheeseburger, piece of pie, fried chicken sandwich--are bad for you and must be routed from your system asap.

Finally there's the ubiquitous BMI calculator and BMI chart. Once more with feeling: The idea of "ranges" is beside the point, especially for growing children. What's healthy for one child at one point in her life will not be the same as what's healthy for another child, or for the same child six months later.

I call this Bullshit 101. And I'm ever so glad my hard-earned money will no longer be going toward creating such appalling crap.

Off-topic: Need a laugh?

These came to me from my dear husband, who got them another blog, and I just couldn't resist.

Here are the top nine comments made by NBC sports commentators so far during the Summer Olympics that they would like to take back:

1. Weightlifting commentator: 'This is Gregorieva from Bulgaria. I saw her snatch this morning during her warm up and it was amazing.'
2. Dressage commentator: 'This is really a lovely horse and I speak from personal experience since I once mounted her mother.'
3. Paul Hamm, gymnast: 'I owe a lot to my parents, especially my mother and father.'
4. Boxing analyst: 'Sure there have been injuries, and even some deaths in boxing, but none of them really that serious.'
5. Softball announcer: 'If history repeats itself, I should think we can expect the same thing again.'
6. Basketball analyst: 'He dribbles a lot and the opposition doesn't like it. In fact you can see it all over their faces.'
7. At the rowing medal ceremony: 'Ah, isn't that nice, the wife of the IOC president is hugging the cox of the British crew.'
8. Soccer commentator: 'Julian Dicks is everywhere. It's like they've got eleven Dicks on the field.'
9. Tennis commentator: 'One of the reasons Andy is playing so well is that, before the final round, his wife takes out his balls and kisses them... Oh my God, what have I just said?'

It stands to reason

that if your knees have deteriorated enough to limit your mobility, you are less able to exercise. But that little piece of common sense hasn't stopped the British health care system, which refuses knee replacements to Britons who are considered "clinically obese"--with BMIs of over 30.

Now a study from the University of Southampton demonstrates that yes, Virginia, fat people benefit from knee replacements, too.

Just for a little context: My BMI is 30.9. I am a physically active person who bikes or walks to work (3 miles), runs up stairs, bikes 8 or 10 miles for fun, and loves to go dancing. If I needed a new knee, I would be one pissed-off person if I was told I was too fat to get one.

For once, common sense may prevail. Though let's see if the NHS changes its policies before we celebrate.

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.