ED Science Stuff

Slimming for Survival? Again?

Last week, in the prestigious journal Science, researchers posted the latest in the saga of calorie restriction and life extension.  Remember the dieting, life-prolonging studies in rodents and the 890 calorie-a-day, life-extending regimens in people?

 

Now, in a decades-long study of monkeys on a restricted diet, researchers found that those which ate less lived longer -- and healthier. 

 

Here are the details: Back in 1989, scientists gathered 30 “adult” rhesus macaques and gave half open access to a buffet of monkey nutritious foods and the other half the same nutritious diet, but less of it. As some animals began to die off, researchers added another 46 monkey to the study in 1994. Over the next two decades, the scientists tracked the lives and health of the primate. It turns out that today, with 33 monkey left, half of the animals permitted to eat freely have survived, while a striking 80 percent of the monkeys given the same diet, but with 30 percent fewer calories, have ripened into monkey old age.

 

Beyond added years of life, the calorie-restricted monkeys developed fewer cancerous tumors, showed less heart disease and lowered their risk or incidence of diabetes and impaired blood sugar control. None of the calorie-restrictors got diabetes. Finally early results show a protective effect of calorie restriction on brain health, including preserving memory and problem solving capacity.

 

This would seem a boon to aging-conscious, health advocates.  The researchers themselves are singing the study’s promise: "We have been able to show that caloric restriction can slow the aging process in a primate species," says Richard Weindruch, a professor of medicine in the UW-Madison School of Medicine and Public Health who leads the National Institute on Aging-funded study. "We observed that caloric restriction reduced the risk of developing an age-related disease by a factor of three and increased survival.”

 

But -- and there is a big “but” -- people need to treat these results with caution. Eating disorders researchers also know of another cluster of studies which show that being underweight can actually double the risk of death -- and that some degree of extra weight is associated with longer life – (heavier people are at a higher risk for death due to diabetes and kidney diseases but a less at risk for non-cardiovascular, non-cancer causes of death, such as infections).

 

Meanwhile, geriatric researchers such as John Morley, at St. Louis University, who was one of the first to study eating disorders in older patients, has also shown that that intentional weight loss in women older than 60 can hasten hip fractures and can increase the odds of going to an institution for care by 1.6 times. Weight loss in late life also lowers immune function, leading to susceptibility to infectious diseases such as pneumonia.

 

To make sense of these conflicting studies, then, we have to realize that weight is a question of balance. Morley, who grew up in Africa where attention to starvation is as paramount as attention to obesity, says “Americans often have trouble with keeping two opposite ideas about weight in their minds at once.”

 

In simple terms, weight loss is good AND bad. Weight loss is good if obesity is an issue. At the same time, weight loss is bad in later life or if a person has grappled with an eating disorder such as anorexia, for example.

 

The danger for studies such as the monkey one is in overgeneralization. Given a prescription for calorie restriction to live longer, people will go rushing to starve themselves willy nilly– and put undue stress on the body. And then the same people will get sick of the low-cal limits and binge or overeat– leading to more stress on the body.  The salient message, says Morley, is weight stability – we must find the balance in eating and body weight and retain that equilibrium throughout life.

 

Bone appétit!

 

A Fish Story: Eating Disorder Style

Even Goby fish do it.

Dieting, that is.

Why, you may ask? You’d think that dieting would be a death sentence for a tiny osteichthyes, no bigger than a bloated paper clip. But some goby fish see slimming down as survival.

In essence, gobies, lower on the ladder of piscine hierarchy, starve themselves to minimize their threat to plumper, more powerful leaders. Starving is a way out of imminent confrontation.

This fish story doesn't just have import for our marine friends; it bears on human behavior as well and brings] to mind several of the marriages I profiled in Lying in
Weight: the Hidden Epidemic of Eating Disorders in Adult Women.

“Who partners up with a woman weighing 85 pounds?” I asked.

The answer: any one of five categories of men (or women if the male is the one with the eating disorder or the relationship is same-sex). The so-called, “Macho Man, Control and Conquer,” is like the superior goby acting in concert with his inferior, anorexic wife/girlfriend.

The husband/boyfriend could be an executive, doctor, attorney, military officer, or minister. He’s the man used to managing other people, assigning duties, and being aggressively IN CHARGE. He chooses a partner with an eating disorder because she will accept his alpha position, and by extension, her subordinate one. She starves to shrink into her Stepford role. As a bonus, she’s slender and trophy-like in appearance. All the more reason for him to stay with her.

However, human beings aren’t gobies. The fish find power imbalance as the key to maintaining a stable, noncompetitive society. The fish can maintain smaller sizes without becoming mentally ill.

Humans are a different story.

Take one common scenario: a woman in this situation shrinks down to “feel loved.” But she eventually realizes -- and admits -- that her partner does not love her for her. He loves her for what she can do for him. And as his dominance continues, she regresses into self-loathing. She does more of the eating- disordered behaviors such as starving, vomiting and/or exercising to excess. Finally, she becomes so sick that she is hospitalized and/or unable to fulfill her duties to him. He, then, dumps her for someone better able to do the job.

Another scenario -- and the one I like so much better -- is the woman who reaches her breaking point. She taps that strength buried inside her and fights back, not with food, but her voice. She swells up in her body, as well as personality. And the couple renegotiates their relationship. Or she, healthier, leaves him to look for a better partner. After all, there are more fish in the sea.

Healing? Express It

At a talk I gave last fall, one audience member, a psychiatrist, asked me what I thought helps people recover from an eating disorder. My answer, in a word, is self-expression. Among the nearly four dozen women I had interviewed for Lying in Weight those who had reached bottom and then somehow found their way back had all embraced some kind of creative endeavor.

 

These women wrote, painted, danced, advocated, designed, blogged, and social networked (in a good way) their path to wholeness. And as they journeyed forward, unpeeling layer after layer of calcified hurt and pain, their projects expressed their odysseys.

 

Sometimes, the project fostered the growth. Others, the healing inspired the project. Healing and creative endeavor are chicken and egg. And so to promote healing, as much as we work the program, be it cognitive behavioral therapy, interpersonal psychotherapy or other, we must allow ourselves the opportunities for self-expression, in whatever form feels right.

 

A recent example of such an opportunity comes from Monica Ibarra-Robbins. She friended my on Facebook with a note saying that she, too, had suffered from an eating disorder. To try to break free, Monica had created a "visual diary."

 

"Unable to express my emotional turmoil," she writes, "I searched for a way to expose the monstrous 'being' that fully dominated my thoughts and feelings."

 

A friend gave her a sketchbook, “to doodle.” Monica used it to purge her feelings onto a black canvas. The result is a gallery of growth, filled with setbacks and hurt as well as breakthrough and liberation. In short, Monica has created a graphic trajectory of recovery, how it really happens, which is not a straight line from sickness to health, getting better every day. In truth, recovery is messy, circular and sometimes very lonely.

 

Reaching out in any form can help.

 

For therapists, a patient embracing a creative project can be an outward sign of internal progress. Eating disorders tend to be very egocentric, and they tend to force preoccupation with pain and the body in pain. A patient can lose sight of his or her creative potential. But it is there. It just needs to be tapped.

 

“In fact, an eating disorder, at its core, is a creative act,” says Joanna Poppink an eating disorders therapist in Los Angeles, also active on Facebook and the Internet.

Remember, if you are suffering, you probably hatched an eating disorder as a means to survive extraordinary psychological pain. Why not try something else, equally creative? By virtue of your eating disorder, you already know you can.

Eating in the Middle

There’s a trend afoot. It’s an epidemic. Seasoned executives, judges, and artists are quietly disappearing on sick leave. Auburn-haired grandmothers, who drive Mini Coopers and carry iPods, are foregoing the chance to take their grandchildren to the zoo. Just when these women should be in the prime of their lives, confident about whom they have become and the choices they have made, they’re in trouble. Women are checking in for eating disorders treatment in numbers at least triple those of 10 years ago. The greatest surge has occurred just in the last 5 years.

“We are seeing more and more older women seeking help and attending our monthly support groups”, says Janice Bremis, Executive Director, Eating Disorder Resource Center, in Campbell, CA.

Early data indicates that the upsurge consists of three groups of older women: those who develop a problem for the first time, those relapsing in midlife, and those with a chronic pre-existing problem who have only now decided to get help.

It seems that something about contemporary aging is stirring up latent eating disorders. But something about aging can also prompt treatment.

So what’s the connection between middle age and eating issues? There are no fewer than 15 life changes that can happen in midlife; experiencing an empty nest, going through menopause, and getting a divorce are just a few. These life stresses can begin or awaken latent eating disorders 

Indeed, eating disorders evolve. They wax with the stresses of marriage, pregnancy and, of course, midlife. Eating disorders wane with the joys of passion, be it childrearing, career, or personal endeavor. For example, some women who struggled with bulimia nervosa in their younger years stop vomiting by their 50s. But they may pick up over-exercising as a replacement. Exercise can be healthy. But over-exercising is not. It is a form of purging. Too much exercise takes a bigger toll on an older body as compared to a teen’s, causing more sports-related injuries, osteoporosis and more severe medical complications.

If you are suffering when older, it may be especially hard to admit a problem. You may believe you are a double loser: first, because you have the eating disorder, and second, because you think you should know better.

The truth is that eating disorders are terrible diseases. And they affect anyone at any stage of life. Eating disorders experts are now more aware of the special needs of women in midlife. The treatments may involve a mix of psychotherapy, drugs, and/or group therapy with other individuals at the same stage of life. 

Even more hopeful, an older woman has seen a lot more than a teenager. That life experience can help her accept therapy more readily than a rebellious teen.  In fact, many women come in for treatment for the first time in midlife and actually benefit more than adolescents. Older women often pay their own treatment bills, so they don’t want to throw their money away. Older women understand that time is running out. And more importantly, older women can be, simply, more ready.

Metrosexual in Style, Retrosexual in Looks

This is the third in a series of blogs that explore the "isms" -- weightism, heightism, sexism and racism.Brandeis student Julie Goodman explores sexism, according to men, and the ways we discriminate based on body attributes that can't be changed -- except by drastic means.

We’ve come a long way from the Brawny man, created in 1974 to sell paper towels. With his flannel shirt and crossed arms, he looks like a nonchalant lumberjack. He looks like a real man.

But times have changed since 1974 -- as has the Brawny man. Modern male icons idealize a different aspect of the masculine. Take your typical cologne model, for instance -- tan angular face, straight white teeth, and a thick head of dark hair. No flannel shirt for this guy. In fact, he’s not wearing much at all, showing off his bare, chiseled abs gleaming like the plastic six-pack on Barbie’s boyfriend Ken.

Today’s idealized man, dare I say, appears less “brawny” and is more beautiful, like the typical glowing female we are accustomed to seeing in magazines. Guys are increasingly feeling the pressure to pay attention to their appearance, and the gap between male and female attentiveness seems to be fast closing. But is it?

Contemporary males and females both feel tremendous pressure to attain an ideal. In a 2007 survey by UCLA researchers, the majority of women and more than one-third of men expressed interest in plastic surgery. In addition, 21 percent of women and 11 percent of men described themselves as unattractive, and 31 percent of women and 16 percent of men reported feeling so uncomfortable in a swimsuit that they avoid wearing one in public.

While men suffer the same scourges of body-envy that women do, they are up against a wall that women don’t have to face. As a society, we’ve grown to expect women to obsess about their bodies. In contrast, we expect flippancy from men. Guys just aren’t supposed to care about how they look; they should be retrosexual, the opposite of a metrosexual, who cares absolutely nothing about appearance. Apart from showering, shaving and applying deodorant, grooming rituals for "Average Joes" are frowned upon. Too much facial hair trimming, cologne-splashing or heaven forbid manicuring takes an ideal man into the realm of the metrosexual – and beyond.

“In a lot of guys’ heads, it is not macho to smell like [crap] and not shower,” says Arthur Serer, a student at Brandeis University in Waltham, MA. “But among most guys, excessive grooming is associated with gayness.”

The subject of grooming rituals is so fraught with stigma among men that even discussing it is taboo, particularly with other men. “A lot of guys would not have even agreed to this interview [if it were] with a guy,” Serer confided. Indeed, imagine two men sitting over coffee, comparing manicures, hair-color treatments, or waxes in the groin area. Without sounding too naively stereotypical, these conversations just don’t typically happen among straight men.

So men are left trying to reconcile a new ideal of attractiveness with old societal expectations regarding masculinity. These attempts, shrouded in secrecy, yield an absurd result that is clearly articulated by C.J. Pascoe in the book Dude, You’re A Fag: Masculinity and Sexuality in High School. In essence, “masculinity becomes the carefully crafted appearance of not caring about appearance,” Pascoe writes. We see it today as the five-o-clock shadow look made famous by Grey’s Anatomy’s Patrick Dempsey, which by now has trickled down even to Disney superstar Zak Efron. While scruffy in appearance, the look requires careful grooming. You want to look nonchalant, like the Brawny man. But you don’t want to look like you spent a month in the forest.

This pressure paradox creates difficulties for today’s men. On the one hand, they face new expectations from women who are now achieving financial independence and are seeking attractive and sensitive, rather than rich and stoic, partners. On the other hand, men also must face their buddies, who may label sensitivity and careful grooming as homosexuality. Nowhere else is male-to-male homophobia more visible than in American high schools, where young men are still searching for their identities. In high school, the line between stereotypical heterosexual and homosexual behavior is rigid and cannot be crossed.

To illustrate this dynamic, Pascoe recounts an anecdote from River High School, located in California. Because male students were so worried about appearing to care about their looks, none would change their clothes after autoshop class, even though they were greasy from working with car parts. In high school, nonchalance rules.

It rules elsewhere, too. Middle-aged men going gray still want to look young and sexy. But they don’t want to use hair dye for fear of seeming like they care about looking sexy. To reconcile their dilemma, these men turn to products like “Touch of Gray”’ hair dye. The concept is to achieve sexiness in age -- salt and pepper hair without too much salt or pepper.

And how do guys talk about this dilemma?

They don’t. They rationalize, keep secrets, and fib. If a man gets his hair trimmed at a hair salon, he certainly doesn’t tell his buddies where he’s going. Cuts are done at barbershops or no-frills places like “Supercuts,” not a salon. If he carefully picks out an outfit each morning, he “will do it on his own” and pretend he threw on random clothes, according to Serer. And if someone does find out about his grooming habits, he may use the ultimate rationalization – the hair gel or the coordinated outfit was all to “get the girl” or the job. Unlike women, who can compare eyebrow waxes, makeup brands, and exercise regimens with each other, men cloak their body concerns in secrecy.

I’m not advocating an increased acceptance of body obsessions for men. We have seen the ramifications of pervasive appearance anxieties in women through the explosion of eating disorders and deflated self-image – clearly the pressure to primp does more harm than good. But while we should not reproduce the worries of women in the male population, we can at least learn from how women deal with these issues. They talk with other women at work, at home, and in public. They write books and articles in protest. They do not suffer in silence. Our men can do the same – they are stronger than secrecy. If only we could get them out of the closet.

Julie Goodman, a student at Brandeis University, co-authored this blog.

What's the Anti-Fat Message, Really?

I recently talked with kids about body image at my daughter’s middle school. Amid the deconstructing of celebrity photos and frank discussion about fat-teasing, I what messages the 12 and 13-year olds were taking home.  Then today, a student’s mother sent me her daughter’s blog entry, prompted by that visit.  It says a lot about the anti-fat battle our kids are weathering…

THINK!

By Jordan

          Tell me something, is it really going to help me feel better if people tell me that they were the same size as me five years ago and I just need to grow into my weight?  ONE WORD – NO!  I mean that I think that I am beautiful and stronger than most people I know (not to have a big head or anything).  People try to help me so much by telling me that I shouldn’t care that I just feel worse!  If you really think about it, by telling me that, it makes it seem like it’s my fault that I feel bad about what people say.  So obviously I feel worse and worse and worse.

          But anyway, I haven’t written in a while because I have been trying to not freak out and get all depressed.   About a month ago, we got new seats in history class.  I got put next to this very rude boy named *****.  During a quiz that day, he was making sooo much noise.  My friend ***** told the teacher that he was being annoying; and I stupidly told him that he was being annoying.  When I talk, I subconsciously say “like” a lot.  He said “like, like, like, like like”.  So I said “like, like, like, like, like”  Then, of course, he said, “like why don’t you lose some weight”.

          As if my day couldn’t get anymore defeating, one girl’s mom came into class to talk about eating disorders.  A few of the guys who had called me fat in the past were sitting behind me and my best friend.  The one guy who has been most persistent with all these “jokes” had whispered my name when the woman presenting got to the part about bingeing, more than once.  Not that I was surprised or anything, but it still hurt.  Then, everyone started talking to me about power yoga (because I love it!), but in a negative way.  They would jus task me things like, “why would I do it, and stuff that was so unnecessary.

          Right now, everything has calmed down, but I can’t help but think about what people are saying behind my back.  Every little whisper and laugh in my direction kills me.  The most recent thing that has happened wasn’t even in school.  Last Sunday I went shoe shopping for my friend’s Bat Mitzvah at Cole Haan.  I got a pair of heels that I really liked and tried them on.  The guy looked at my feet and said, “these shoes only have a 5% give.  It isn’t at all enough for her foot.”  It may seem stupid, but the way he said it was so demeaning.  Bad shoe salesman, don’t you think?  I would have bought the shoes if he didn’t say that.  Well, I’ll keep you posted.  I know something else is going to happen soon.  I can just feel it!

 

Jordan is a 7th Grader in Brookline, MA

What's Love Got to Do with Thin?

They do it because they want to help. The husbands and partners of women with eating disorders are performing striking feats of “support” that would make even Cupid proud.

 

An eye catcher comes in the story of Tom Cramer, whose wife Meg slipped into the grip of anorexia. As she continued to waste away, Tom tried to cajole a skeletal Meg into eating a cheeseburger and fries: “If you really love me, you will eat this,” he begged. She didn’t. So he starved himself by her side, just to experience her pain.

 

The “if you can’t beat ‘em, join ‘em” philosophy is an interesting one, especially in the outcome for Tom. After running three miles daily, eating little more than juice and a banana for breakfast and a small salad for dinner, he eventually pushed through hunger to encounter “the voice.” It’s one that many eating disorder victims report they hear in their minds: “Come on, you can do it. Don’t give in. You’re better than everyone else.”

 

As Tom heard it, he got it: “Now I understood the seduction of the words in (Meg’s) head,” he says. “And I saw her as a hero – who had to be incredibly strong in her fight to recover.”

 

Is she a hero? Better yet, did Tom really get it? Hard to say. Tom’s self-starvation experiment only lasted about a week. Eating disorders can last a lifetime, waxing and waning in rhythm with triggers caused by the stresses and transitions of life. One of Meg’s triggers might have been the birth of her second child, which nudged her body weight to an all-time high. Or, much to Tom’s consternation, some hidden dissatisfaction with her marriage might have catalyzed her fall.

 

The idea that marital struggles can actually trigger eating disorders is not a stretch. More than a decade ago, psychologist Stephan Van den Broucke, research coordinator at the Flemish Institute for Health Promotion in Belgium, did a provocative series of studies with couples in which one partner suffered from an eating disorder. To peek behind closed doors at how these couples viewed their intimacy and happiness in love, Van den Broucke first surveyed both partners, asking them to rate on a scale ranging from very true to very false such statements as:

 

“I can be myself in the relationship with my partner.”

 

“I prefer to keep things hidden from my partner.”

 

The results showed that wives with eating disorders were very unhappy in their marriages, while their husbands were not. To find out why, Van den Broucke gathered three types of heterosexual couples: one in which the wife had an eating disorder, another in which neither partner was ill, and a third in which the couple was seeking counseling for run-of-the-mill marital problems. It turns out that couples in which one partner had an eating disorder reported more marital distress than couples with either marital problems or no eating disorder but less distress than couples generally fighting. At the same time, couples with eating disorders scored lower on intimacy measures than did normal couples and only scored slightly higher than did couples seeking counseling for general problems.

 

What this means is that “eating disordered couples are fighting less because they’re interacting less,” Van den Broucke concludes.

 

Simply, an eating disorder starves basic intimacy.

 

Indeed, Tom Cramer notes that as his wife’s disease progressed, she began shunning sex, closeting enticing clothing in favor of baggy sweats that hid her wasting body, and generally falling asleep by 8 p.m., exhausted from self-starvation. She was hiding out from him, in part, because her eating disorder became her primary lover.

 

And where was Tom in all of this? Apparently frustrated enough to starve himself in consort. The whole dynamic is complex, as many marriages are. But when it comes to love and eating disorders, it’s pretty simple - the guys are intrinsically, if not intimately involved. Hence, when she has an eating disorder, they do, too.

 

In researching “Lying in Weight: the Hidden Epidemic of Eating Disorders in Adult Women,” I asked women with histories of eating disorders a vexing question: What kind of a partner stays with an 85-pound anorexic? In answer to this question, I discovered five basic categories:

 

The Nice Guy: Passive and Compliant

This is the “rescuer” who genuinely wants to help her.  He compromises, concedes, and sacrifices – for her. Or so it seems. But sometimes taking care of her is a distraction from taking care of himself and his “stuff.” So he stays. Until she gets better, that is. Because then he’s out of a job.

 

The Knight in Shining Armor

A variation on the passive theme, a Knight in Shining Armor wants to save and protect his eating-disordered damsel – until he realizes that she doesn’t really want to be saved. She wants her eating disorder. Lacking gratitude from her, he tires of fighting her dragons and fights her. He may make sly comments about her eating at parties or he may recognize his helplessness and withdraw. Withdrawal can take the form of an affair, immersion in work, or divorce.

 

Macho Man: Control and Conquer

A Macho Man may be either controlling or kind and loving. Either way, he sees her as an extension of himself. Whether an executive, doctor, or minister, this man is accustomed to managing people. He brings his job home and chooses they type of woman with an eating disorder because she will go along with his behavior. In the worst case scenario, he is abusive.

 

Mr. Clueless: He Just Doesn’t Know that a Problem Exists

By far the largest category of partners, many men have no idea that their partner is sick. That’s hard to believe in the case of anorexia. But with bulimia, in which women can be normal or even overweight, not knowing is not a stretch. Without any real idea of how seriously their wives are suffering, these men genuinely love their partners and believe their marriages are pretty good. An anecdote to illustrate the point –a husband was clueless that his wife who he had been married to for 35 years was actively bulimic until she checked into a treatment center and told him. He was a detective.

 

The Ostrich: Denial and Distance

Question: “If you have a partner with a marked weight fluctuation, how could you NOT notice?” Answer: Denial. In many eating disordered marriages, no one wants to rock the boat. And so the partnership goes on, lacking honest, open communication – and true intimacy.

 

Overall, partners of women with eating disorders are not any more neurotic or insecure than the norm.  However, partners may be ignorant of the disease and all its permutations and manifestations. So if you are intimately involved with someone with an eating disorder, you don’t have to self-starve. But you’d be wise to educate yourself about what eating disorders are and are not. For help, you can click through a wide variety of good resources created by reputable organizations.

 

Eating disorders don’t go away on their own. They don’t heal by love alone. They don’t affect her alone. Eating disorders play out in partnership and intimacy in profound ways. Yes, love has everything to do with them.

The Short End of the Stick

This is the second in a series of blogs by Julie Goodman and Trisha Gura on discrimination based on body attributes (a.k.a. the "isms")

When Barack Obama took office next week, he made history as the first African American president. Race notwithstanding, this past election season was rife with discussions of sticky issues, including gender and age. But what about height?

At 6’1”, Obama towers over McCain, who measures up at 5’7”. Sure, a taller guy might look more powerful, more competent, and more authoritative. But could such a seemingly insignificant characteristic as height really sway voters?

You bet. A study surveying presidential elections from 1824 to 1992 found a positive correlation between the height of winners and the victory margin. And get this – the survey also found that the more worrysome the political, economic, and/or social threats during the election time, the taller the president.  How’s that for a “tall order” of business?

Of course, we would be hard-pressed to find someone in an exit poll who voted against McCain because he was ‘too short’ – but the study suggests that Americans harbor a subtle form of prejudice called ‘heightism,’ in which short-statured people are seen as inherently inferior to their taller counterparts – particularly in times of economic and political trouble.

Like the causes of short stature, heightism can take many forms. Most of us are familiar with the stigma that plagues dwarfs, who have battled centuries of stigmatization.

But heightism also afflicts people without inborn genetic conditions -- those who are “just short.” The medical term used to label this (and shortness is indeed ‘medicalized’) is idiopathic short stature (ISS), or shortness with no known cause. While displaying no medical problems, many individuals with ISS experience psychological problems (think Napoleon Complex). Many short men complain of difficulties on the dating scene and in the workplace, and many short children find themselves the victims of playground taunts and bullying.

Meanwhile, parents navigating in an era when medical treatment often slides into “medical enhancement,” are presented the option of giving their healthy ISS children the latest growth-inducing pharmaceuticals. The drug of choice is synthetic growth hormone, first developed by the biotechnology company Genentech under the name Protropin. The drug reached the market in 1985, just after the National Institutes of Health (NIH) yanked the natural hormone, extracted from cadavers for safety reasons (a few recipients had developed Creutzfeldt-Jakob disease). While the natural hormone had been reserved for kids with growth-related hormone deficiencies, doctors began prescribing the abundant synthetic drug for off-label use in ISS children. In 2003, almost two decades later, the FDA bowed to clinical practice and approved synthetic growth hormones for ISS.

How effective is this drug when given to ISS children? In 20-year study reported in 2008, Dr. Kerstin Albertsson-Wikland and her colleagues at the Queen Silvia Children’s Hospital in Sweden investigated the impact of hormone injections on final adult height.

The study randomly assigned children to either high doses of hormone, low doses, or no treatment at all. The children were then followed until they reached their “adult height.” Not surprisingly, Albertsson-Wikland found that the kids who received growth hormone treatment grew taller than did the untreated children, with the higher dose yielding the most added height.

But there was a caveat: the children had to have parents of normal height. If children were born to just-as-short parents, the growth hormone didn’t work, indicating that other genes and well as the hormones play an important role in height determination.

Some other observations: boys responded better to growth hormone treatment than did girls (Albertsson-Wikland attributed the gender difference to the fact that during puberty, boys more than double their growth hormone production, while girls produce quadruple the amount. Therefore, girls in the study would have needed a higher dose of hormone to proportionally match the boys’ hormonal boost). And finally, despite the general trend toward height increase, each individual child differed, sometimes dramatically, in their response to the drug. 

So is treating short children with drugs the best course of action?

The answer depends on who you talk to.  Albertsson-Wikland views treatment as a form of justice for short kids, who are born with the genes to be taller (as measured by their normal-height parents, anyway) but for some reason aren’t.

ISS individuals born to normal-height parents “are not reaching their genetic potential,” she says, “so there is something wrong with these children.”

Therefore, Albertsson-Wikland believes that such a “wrong” should be righted, and since drugs can do the job (at least sometimes), why not try?

However, critics of growth hormone prescriptions for ISS children argue that the treatment contributes to prejudice and implies pathology where none exists. There are also side effects to consider. The drug is extremely expensive and usually not covered by insurance, raising concerns about social inequities. And in the age of steroid abuse, growth hormone’s muscle-increasing, fat-decreasing properties offer a tempting alternative that can’t be detected by normal drug tests for athletes.

Some physicians agree with the social stance against treatment, but they nonetheless have to practice medicine in the real world. “Sometimes you have to drop your society analysis and look at the individual,” says Craig Alter, Professor of Pediatrics and Clinical Director at the University of Pennsylvania Children’s Hospital of Philadelphia, who regularly sees patients with ISS.

And that individual is a child between 8 and 14 years old, with concerned parents who may have their own agenda. “There is a lot of push from intelligent families that know the system and want to get everything out of it,” he notes. Often it is the parent who pressures the child, and sometimes even the physician, to agree to treatment.

While Alter is conservative in writing out prescriptions for synthetic growth hormone and believes the drug “should be reserved for those whom, in his opinion, “would suffer greatly for psychological reasons without treatment,” other doctors treat ISS aggressively.

As the hormonal controversy and questions continue, so, too, does ‘heightism.’ It can be a stigmatizing as any other “ism” including that related to race or sex. While you determine where your sentiments lie, here are a few steps toward battling height prejudice:

•Be aware of “grow taller” scams.

Many companies market pills as growth-promoting agents. Despite the fancy claims, the ingredients are no different than what you would find in a daily multivitamin supplement and do not encourage growth. Likewise, the hyped stretching and meditation exercises to promote growth also fail

•Become a Heightism Watchdog.

If you see heightism in the media, speak out! You can report incidents to the National Organization of Short Statured Adults (NOSSA), or you can publicize them on personal blogs or websites. NOSSA also suggests contacting the media outlet directly, calling elected officials, and using the power of consumer boycotts.

•Expand anti-bullying policies in schools to include height.

Many schools already have comprehensive anti-bullying campaigns and curricula. Anti-heightism education could easily be incorporated into these efforts.

•Empower ISS children.

Let them know about artists, musicians, and political figures of extreme short stature. Ghandi, for example, only measured about 5’3”. And of course there was Napoleon, who was only 5’6”.

We welcome our first African American President to the Oval Office, showing how far our country has come in battling racial prejudice. Perhaps one day the same justice will happen for smaller individuals.

A short Commander-in-Chief? Let’s take it an inch at a time.

Julie Goodman is a student at Brandeis University, near Boston

"Happy" Holidays

Let's be honest. Many of us (especially those who suffer from eating disorders) dread the holidays - the extra gift-giving demands, gluttonous food, and face-to-face contact with difficult family situations, you name it. And yet, many people really enjoy the shopping, fruit cakes, and reunions.

Holidays are like life, only amplified: If we're generally down, the holidays are miserable. If we're generally optimistic, the holidays are warm and full.

It is with these thoughts that I came across an article reviewing happiness in December issue of Mayo Clinic Women's HealthSource.

Here's what various studies have found about happiness, year-round, and how it may pertain to eating disorders this holiday season.

Money:

Despite American's pursuit of money and the current global woes about it, it turns out that money really doesn't buy happiness. True, struggling with poverty or layoffs does not exactly breed joy. But once our basic needs are met, more money doesn't improve life satisfaction much.

Age:

Age does affect happiness. According to a study of about 2 million people in nearly 80 countries, mental distress peaks at midlife. In the United States, this typically happens for women at around age 40 and for men at around age 50.

This finding has implications in eating disorders' world. Experts have viewed the teenage years as especially precarious. Faced with turbulent hormones, renegade emotions, and changing bodies, adolescents more than any other demographic turns to eating disorders.

Now mirroring the teen crises period is midlife, with its recent surge of eating disorder sufferers. According to Edward Cumella, director of research and education at Remuda Ranch, women in their 40s and 50s are checking for treatment in numbers triple and quadruple that of 10 years ago. (The greatest increase has occurred in the last 5 years such that some treatment centers are reporting more than half of the inpatient population is adults).

There are a multitude of reasons to explain the rise, including:

●more recent pressures to look young

●relapses back to old habits started in adolescence

●the idea that people turn to food and exercise to try and relieve the stress of no less than 15 possible midlife transitions, from menopause to divorce to empty nesting

The good news is that the valley of despair may lift as the "golden years" arrive.  People in their 60s and 70s tend to be as satisfied as younger people. Older people may finally accept their limitations instead of trying to fight them on the treadmill.  Maturity may kick in. Or people in late life might gain an appreciation for life as friends as loved ones die. Happier people may live longer, affecting the data.

Genetics:

Another player in our ability to feel happy is genetics. In fact, genetics accounts for up to half of individual differences in both well-being and positive personality traits, which are closely linked. Similarly, one the greatest factors in seeding anorexia and bulimia are personality traits including anxiety, perfectionism, and impulsivity. Those have their roots in the genes we are dealt.

Life circumstances:

Long-term levels of happiness definitely plummet with major life events such as divorce or the death of a loved one. Marriage and pregnancy can boost happiness. In the same vein, most major transitions can spur latent eating disorders, while a few such as pregnancy can often lead to a respite.

Health:

People in excellent health are almost twice as likely to be happier than those in merely good health. And poor health makes us 70 percent less likely to be happy, compared with those in good health.

So if you are trying to find a bit of happiness this holiday season, especially if you have a history of eating problems, search in the areas likely to make a difference:

●Worrying about money is pointless, since money won't make you happy (as long as you have food on the table).

●You can't change your genes, your age, or the circumstance of your life.

●But you can do something about appreciating the gifts of life and your health. Eat well. Exercise within limits. Take care or your needs. Start there.

Tastes of Seasonal Cheer

Holidays in mind, I’ve been searching for tastes of seasonal cheer from sources other than my plate or glass. My quest has landed this first cupful:

Renowned eating disorder expert Cynthia Bulik at the University of North Carolina and her team have come up with a write-on-a-note card-and-post-it list of tips to help with weight woes as the eggnog flows and the cookies get swapped.

For those who suffer from overeating, the key to getting through the buffets and parties is focusing on “weight maintenance” instead of “weight loss.” In short, forget the crash dieting before, during, or after the halls are decked. Instead:

• Do a plateless reconnaissance mission. When you get to a holiday event – especially a buffet – take a good look around without a plate in your hand, and then choose the main things you want to try.

• Don't skip meals. The “I’ll skip lunch to save up for dinner” strategy often backfires. It is much better to keep regular mealtimes even during the holidays.

• Drink smart. Ask for water and a lime twist rather than alcohol at parties. Alcohol can stimulate your appetite, which is exactly what you don't want to happen. Or alternate; a glass of wine followed by a glass of water.

For those suffering from eating disorders such as anorexia nervosa, the pressures around food (way to much all the time) and family (stuck in old ways of relating) are similar, although the means of coping (i.e. not eating or purging) differs from those who overeat or binge without purging. Some helpful advice includes:

• Go to a party with a wingman. Pick someone who is safe, to whom you can say, “This is really tough for me. I need to take a break.”

• Never go to a party hungry.  Eat a decent, healthy meal before you get there so you're not tempted to binge (or feel stressed by the mixture of hunger and denial of that hunger) when you're at the party.

• Try eating for pleasure. Give yourself that holiday gift, guilt-free – even for one bite.

I would add two more items to the list:

• Start a food diary. Or just a diary. The mix of large groups of family members, alcohol, and an unsaid pressure for everything to be holiday card perfect can be especially difficult for a person who is a consummate perfectionist. Journaling can help you find your center and hold onto it when the crowds get rough.

• Reflect on positive attributes other than body size. Those who suffer eating disorders place huge emphasis on their appearance. Make a list of what you like about yourself beyond your appearance. If you have trouble, enlist family, friends, even children to help.

More holiday thoughts to come.