Eating Disorders and Nutrition News

Where Does "I Feel Fat" Come From?

Dear Readers,

For those of you who have helped or are helping a loved one battle an eating disorder, one of the most puzzling aspects of these diseases can be the absolute conviction of your loved one that she or he is fat, when in fact they are starving to death, or even on the thin healthy side.

There are so many other behaviors associated with eating disorders that are equally inexplicable: Why does your child feel happier and safer the more his bones stick out, the more he courts cardiac or cerebral damage? Why does she crave the ritual of stuffing herself with junk food until she feels sick and passes out? How can she continue starving and purging when she knows eventually her bones will crumble like bread sticks and her teeth will rot and fall out?

Two eating disorder specialists, Johanna Marie McShane, Ph.D., a psychotherapist, and Tony Paulson, Ph.D., a social worker, have written a book designed to explain these mystery, and in general take you inside the eating-disordered person's head. It's called "Why She Feels Fat: Understanding your Loved One's Eating Disorder and How You Can Help," and it is published by, Gürze Books, the publisher of our book.

This is a great idea. As many of you know from reading our book, family based therapy is now considered the most effective way to treat adolescent eating disorders. Yet as much as parents want to help, often they are held back from being truly effective by their absolute bafflement at how their smart, responsible and loving child has seemingly lost all reason when it comes to food, exercise, shape and size.

McShane and Paulson act as psychological translators, explaining the complex web of emotions that lie beneath exclamations such as “I feel fat,” or “I feel chaotic and out of control.” Eating disorders, they explain can be many, many things: A way to feel secure; a way to make life feel predictable, a means of communicating emotions. They can impart a calming sense of “being in control” for the child who feels his life is entirely out of control. And, as we saw with Dr. David Herzog’s book (see my April 20 post), eating disorders can be a way for the child to prove that she is “good enough,” even as she fears and believes that she isn’t.

Eating disorders, the authors explain, aren’t really about being thin (although the desire to be so, fed by our thin-obsessed culture, can be the launching pad for an eating disorder); they ultimately become a cherished coping mechanism.

After reading this book, I was struck anew by how similar an eating disorder is to a negative and destructive personal relationship. Your child’s world has shrunk to the point where this isolating relationship is all she has in the world. She clings to the relationship, having come to believe that without it, she is nothing.

You may have to fight the fight of your life to extract your child from this destructive relationship, but once you understand the anxieties and fears that lie below all the inexplicable food behaviors, you will have an easier time emphathizing with your child, and a better chance of winning the battle.

Good luck and take care,

Nancy

Are Eating Disorders Contagious? I Don’t Think So!

Dear Readers,

A new study of eating disorders among high school students is getting alot of press. Researchers in a study (published in the International Journal of Eating Disorders this month, April 2008) found a small “clustering effect” in female students. This means that girls who live in the same county with girls who either starve, diet, over-exercise, binge, or use diet pills are 4 percent to 10 percent more likely to engage in eating disordered behaviors than if they lived in counties where these behaviors are rare. These results are leading some to conclude that eating disorders are contagious. I worry that too much focus on “contagion” could lead to isolation and discrimination against girls with serious eating disorders.

French and British Politicians Make Eating Disorder Headlines

Dear Readers,

This week has had interesting reports from Europe. First, France is considering legislation that would make promoting eating disorders a crime punishable by fines and imprisonment. Though it is hard to imagine how one could prove that this website or that diet caused an eating disorder, but nevertheless, it is a good sign that the French are beginning to take eating disorders seriously.

Unlocking the Mysteries of Eating Disorders

Dear Readers,

I just finished a new book that many of you will want to know about, Unlocking the Mysteries of Eating Disorders: A Life-Saving Guide to Your Child’s Treatment and Recovery (McGraw Hill, 2008). It is written by David B. Herzog, M.D., a Harvard psychiatry professor and head of The Harris Center at Massachusetts General Hospital; Debra L. Franko, Ph.D., a Northeastern University psychology professor and Harris Center associate director, and Pat Cable, R.N., the Harris Center’s director of publications.

Marcia and I know Dr. Herzog to be one of the most compassionate and expert professionals in the eating disorders field. He and his colleagues have written an eminently sound guide. You hear the voices of lots of parents and their kids who are struggling with eating disorders, both boys and girls. I especially liked the section on setting up a treatment team for your child, which is broken down into important issues and questions that should be asked, as well as the section on the use of antidepressants in treating both bulimia and anorexia.

One common denominator the authors find among their patients is the feeling, “I’m not good enough.” They note that eating-disordered kids come from a wide variety of backgrounds: some report idyllic and happy childhoods, some have a history of trauma or abuse. “The paths that lead to ‘I’m not good enough,’ differ from one person to another,” they write.

A good piece of advice is to counsel your perfectionistic child  to strive for “excellence, not perfection.” The authors explain, “Excellence is achievable; perfection isn’t.”There is also a very helpful section on how to appeal a denial of coverage from your insurance company.

In short, this is a book well worth reading.

Take care,

Nancy

You Don't Look Anorexic!

Last weekend, I received a call from Andrea, a former patient who is away at college. Andrea called me from a hospital emergency room in tears because a doctor had just told her that she didn't look anorexic.

The Power of Grassroots Support Groups

Dear Readers,

I just had a good exchange with Lily Cuadra from the Broward County, FL chapter of ANAD (National Association of Anorexia and Associated Disorders). ANAD is devoted to helping individuals and their families find eating disorders resources and provide referrals to professionals. There are over 350 ANAD-affiliated support groups through the U.S. and in 18 other countries, all of them free of charge.

I learned that for your group to represent ANAD, you need to find a professional sponsor. Lily joined up with two friends, one of whom was Nikki Kramer, a primary therapist at the Renfrew Center in Coconut Creek, FL. Nikki was able to serve as the group’s professional sponsor. Only 16 months after launching, their group has over 100 people on its mailing list, and anywhere from 12 to 20 people attend their twice-a-month meetings! It’s inspiring to hear about grassroots support groups like this springing up and bringing hope to people in the region who may not have had anywhere to turn to before. Good luck to you and your group, Lily!

Take care,

Nancy

Miss Bimbo: More dangerous than Barbie!

This past February 2008, a new British website was launched which has  parents rightfully worried. Miss Bimbo.com lets young girls play a virtual fashion game using diet pills, dieting, breast implants, and plastic surgery to create the “hottest, coolest, most famous bimbo in the whole world.” Find out more @ http://edition.cnn.com/2008/WORLD/europe/03/25/miss.bimbo/

Peace, Marcia

Fashion and Body Image: A Deadly Combination?

Dear Readers,

In our book, Marcia and I discuss the importance of media literacy, and educating your children on how to be a critical consumer of mass media. I was reminded of what can happen to those who haven’t been given this kind of education recently when I attended a very good public forum on body image and fashion in Cambridge, MA.

Titled “Redefining Perfection: Beauty, Fashion and Body Image,” the forum was sponsored by The Harris Center, formerly known as The Harvard Eating Disorders Center (which is headed, incidentally, by the excellent Dr. David Herzog, whose new book I will write about next). Speakers included Kirsten Haglun, Miss America 2008; Paige Adams-Geller, a former Miss California and founder of Paige Premium Denim, and Bradley Bayou, former creative director for Halston, who now dresses Oprah, Halle Berry and Deborah Messing, among others.

All three panelists have personal ties to the issue of eating disorders. Haglund and Adams-Geller are both former anorexics. Haglund has made eating disorders education her “platform,” or main topic as she criss-crosses the country speaking. Adams-Geller, once an anorexic model and USC student who survived days on end eating only rice cakes, transformed herself into a successful “fit” model for jeans, then parlayed her expertise in jeans fitting into her own $100 million company. Paige Premium Denim makes the importance of maintaining a healthy body weight and healthy body image an integral part of its message. Bayou woke up to the issue of eating disorders when his own daughter was diagnosed with bulimia four years ago when she was 25.

Bayou recounted how the saddest day of his life was when he learned of his daughter’s diagnosis, and recalled how, as a child, she had tried so hard to fit into his own line’s sample sizes an an effort to get his attention. Then he launched into an attack on the fashion industry, especially fashion editors, for failing to take responsibility for the negative message they are sending to young Americans. By only publishing pictures of anorexic-looking models, said Bayou, they are setting the standards  by which top designers, models, and modeling agents have to live.

Bayou also placed some blame on the CFDA (Council of Fashion Designers of America) for being “unwilling to stick its neck out” and legislate stricter rules against underweight models. Spain and Italy, Bayou noted, have both instituted such rules, and in those countries 30 percent of the models who worked the runways last year were too thin to work this year’s shows.

Adams-Geller talked about how it was nearly impossible to get normal sized models for her denim fashion shows. She prefers models who are around size six (still hardly an accurate reflection of the average American woman) but no modeling agent represents models bigger than size 0 or 2.

The forum was a good reminder that since the fashion industry, including the fashion magazines that create consumer demand, are not changing their ways, it’s still up to parents and educators to teach children that the female (and male) “glamour” figures they see in magazines, movies, on tv and in music videos do not reflect reality. Instead, let’s teach our kids to look elsewhere for role models: to scientists, writers, activists, musicians, educators, or artists, people who are celebrated for what they do, not how they look.

Take care,

Nancy

Orthorexia

A new twist on anorexia is “Orthorexia,” a compulsive and obsessive preoccupation with healthy eating. Orthorexia is NOT an official diagnosis, but it is very similar and as life-threatening as anorexia nervosa.

The Mess Behind the Kimkins Diet

The Kimkins Diet bills itself as a "lean, low carb plan which has less fat than Atkins, less carbs than South Beach and faster weight loss than Weight Watchers." Kimkins is a particularly dangerous diet because the calories are so low (around 800 calories or less) that serious health problems like gallbladder disease and hair loss have been reported.