Monday, October 30, 2006

The Last Supper

On an episode of Will & Grace, Grace and Karen are finishing up a restaurant meal when the leftovers are doggy-bagged and delivered to their table. Grace exclaims, “Yay! I’m so excited! I can’t wait until I’m hungry again!”

It’s curious how difficult that is for most of us—the idea of stopping when we’re full and waiting until we’re hungry to eat again. For many, it’s the most difficult part of mindful eating—learning when to say, “When.” Problems may arise particularly at night, when the last meal of the day unconsciously registers as “The last meal.” It’s hard to put an end to dinner when breakfast seems so far away.

So, why this difficulty, this distress about “enough”? Perhaps we’ve historically restricted, dieted to the point of our bodies’ cells not quite knowing when the next fix will come—and so, better to pack it in now. It’s as if a part of us has acknowledged that we may never eat again.

On a simple level, problems with parting usually occur with food that tastes good—our sweet, salty, or savory compadres. It’s not too often we overhear, “I just can’t stop eating these lima beans.” Tasty food provides comfort—comfort to our mouths and our minds, heralding a short-lived era of “I deserve.” And, generally, eating is reminiscent of an earlier time when our infant minds were only vaguely aware of some distress that was assuaged at the first ounce of milk.

But, it’s also possible that pushing the plate away mirrors other endings we experience—releasing, letting go, saying goodbye. How we say goodbye to food may mimic how we say goodbye in life—are we trusting, knowing that we’ll again find solace, comfort in others and ourselves? Or, when parting, are we distressed, fearful that we may never be okay?

Wednesday, October 25, 2006

Celebrity Chatter


In November’s issue of Self magazine, Lost star Evangeline Lilly, 27, reports that, after a recent stint of undereating and over-exercising, she realized, “‘I didn’t have an eating disorder, but I was pushing myself too hard for the calories I was taking in, and it wore down my immune system.’” Now, Lilly has dropped her three-hour daily workouts down to an hour, and is “‘not depriving [her]self anymore.’” But, there’s still a psychological struggle:
“I’ve always hated that my hips are smaller than my thighs, but I also take pride in that, because I want to be somebody who young women can look at and go, ‘Ok, she’s not perfect, so it’s OK if I’m not either.’”
Kudos to Lilly for recognizing (and avoiding) the entrance to a slippery path and for recognizing her role-model potential. Will it really make a difference? A recent issue of In Touch Weekly quotes Lilly as saying, “‘I come from a family of women with big thighs,” and notes that her workouts can “go a long way toward smoothing her lumps and bumps.” Other celebs targeted in the same “Even Stars Have Cellulite!” feature: Scarlett Johannson, Mischa Barton, Christina Aguilera, Kate Moss, Jessica Simpson, Uma Thurman, and the Hilton sisters.


An interview with Rachael Ray, in the same issue of In Touch, asks of Ray, “How do you stay in shape?” Ray replies, “I don’t! All of my pants are stretch and some days I’m a size 4 and other days I’m a size 6. I’ve never loved clothes enough to give up food!” Well, in addition to the fact that sizes 4/6 are, (body composition aside) generally understood to be “in shape,” and certainly not requiring of a fashion-inspired fast, I’m (in all honesty) quite ashamed that I thought she was bigger than this. Again, I’m reminded of the pound-loading camera and, likely, more of the generally skewed shapes we’re conditioned to seeing—how disturbing is it that the typical size 0/2 we view on television, in movies and magazines can make a still-petite woman seem larger than she is?

Tuesday, October 24, 2006

Weightstaff

Everything, everything has to be about weight.

I’m flipping through Zagat’s in search of a restaurant I’m soon to visit. The description reads:

“Reliable Carribean bites are washed down with perfect mojitos at this affordable, feisty (read: loud) SoHo scene; the lounge-like step-out-onto-the-beach d├ęcor furthers the fun vibe, as do the cute, pencil-thin staffers, even though service can be iffy.”

Pencil-thin staffers. In New York? You’re kidding me. Having now dined at said restaurant, I can say, without hesitation, that my actual experience of the establishment’s “fun vibe” was in direct proportion to the pencil-thinness of the waitstaff. Iffy service? Child’s play. . . as long as the servers are skinny.

Thursday, October 19, 2006

Stories: Part I

With permission. . .

INTRODUCTION

I'm 43, 5'8", 180 pounds. My first memories of feeling fat come from about age 6. I was always in the top area of the growth percentiles for weight and height, and I remember the doctor lecturing my mom about how I was "going to be fat" if she didn't "do something." The alcohol smell of the exam room, the lights bright on the doctor's white coat, his pointing, hairy finger. Pointing at me. The frown on my mom's face. The feeling that I'd done something awful to her on purpose.

Since then, I've felt people's judging eyes on me: lonely, dumb, lazy, no control over her eating, spends whole nights on the couch in front of the TV with a pint of Ben & Jerry's.

None of that is true.

Lonely: No. Outgoing. I have an easy time making friends, which is how I survived school as The Fat Kid. In an 8-year relationship with a great guy (after divorcing a not-so-great guy; married 11 years that time).

Dumb: No. Last IQ test 153; graduated from college Magna Cum Laude.

Lazy: Lazy people do not graduate Magna Cum Laude. Nor do they rise at 5:00am on weekdays so they can go to the gym. Also, I don't own a car, so I carry all my own groceries, walk for errands, and so forth.

No control over eating: I haven't eaten beef, pork, or chicken since 1980. I eat very few processed foods, and snack cakes, etc leave me absolutely cold (what exactly *is* Cool Whip made of?).

Couch, TV, B&J: We have a couch. But we don't have a TV. And I'm allergic to dairy (actually allergic, not lactose-intolerant) so I've never even had Ben & Jerry's ice cream.

Non-fat people simply don't get it. There isn't one set of circumstances that makes all fat people fat.


WHAT HAPPENED

So what are my circumstances? Simply put, anorexia. It started in my teens. It wasn't a wish to have a certain body size and shape, although, like other girls, I did have those wishes. The anorexia went deeper. My logic was that perfect people don't eat too much; therefore, someone who never eats anything is the most perfect of all.

Not eating at all feels great. It's so exciting--I'm free! Free of stupid food! Hurray! Of course, my body disagrees. When I was a teenager I lived on about 300-500 calories a day. I skipped breakfast and lunch, ate a tiny snack after school and then some dinner but not very much.

I was praised to the skies for this behavior. Friends, parents, teachers--they were all thrilled that I finally "had control" over my eating habits. Of course the crash came. I couldn't keep that up forever, I gained a little weight, and presto, I was The Fat Kid again.

I should add here that I always ate "healthy" food, simply because it's what I prefer. My mom cooked everything. In the late 70s we all read Diet for a Small Planet and by 1980 I was a non-strict vegetarian, which I still am today. I'm a total food snob; I don't like chips or snack cakes or the other stuff fat people are supposed to like. When I went on Weight Watchers in 2002 (more about that later) I had to ask somebody what "Little Debbies" were. Of course, I won't say no to vegan flourless chocolate cake, so I'm not claiming superiority here--just pointing out yet another way in which the "fat person" stereotype is a lie.

I hovered around 180 for the rest of my teen years. Then I got married and gained a bunch more, up to about 220. I stayed there until I discovered exercise at 27. I'd always hated gym class, but it turned out I was a really good weightlifter. If you think about it, it makes sense. There are no weedy aristocrats anywhere in my family. I come from about ten generations of farmers. Of course I'm good at lifting weights. I was built to carry buckets of water, sheaves of wheat, newborn calves.

Exercise made me lose the excess, and without changing my eating habits I got down to about 180 again. Then I started college. I was 30.

I didn't go before because I couldn't afford it; I'd become an indifferent student in the later years of high school (probably thanks to my low blood sugar) and Ronald Reagan's changes to student loans basically torpedoed my chances. I left home early, longing for independence, and worked various drudge jobs. But after I got a divorce I decided it was now or never.

School was a huge stress. At the end of the first day, I stopped eating, like I had in high school. My clothes fell off me, which was a problem because I was totally broke. And again, the crash came about a year later--there I was, 180 again.

After graduation I went to work at a very successful dot-com enterprise. I made a lot of money, but 60 hours was a "short week." I was in a chair, in front of a computer, most of the time. I'd stopped exercising--when would I go to the gym? My entire life was dominated by the thought that I should be at work.

Three and a half years later, I got laid off (2001). I weighed 252 pounds. The 72 pounds was mostly huge dinners out, which I could afford. I ate at least one huge meal out every day, and most days it was more than one.


WHAT I DID ABOUT IT

So there I was--too fat to do anything. I'm an energetic person and it was driving me crazy. I couldn't go take a walk; it made my feet hurt too much. I could barely go to the grocery store. I was so out of shape, but I had boundless energy. I was slowly going crazy.

I hired a personal trainer who helped me get back into exercising again. I haven't stopped since. Some people are scared of being fat because they'll look bad, but at this point, I'm scared of being that out of shape again. I felt trapped.

This time, not that much weight came off, and I still felt trapped, although less trapped. So in 2002 I joined Weight Watchers online. It worked; I got down to 168. Then my "points target" changed and that was the tipping point. My food was too limited. A voice in my head told me, "You're a bad person!" every time I ate something. I hated that little voice. I was afraid of never being able to eat again. I started defying the diet--and for all WW says they're a lifestyle change and not a diet, they're wrong. Eating only so much per day, no matter what you want or need, is a DIET. Limiting food is A DIET. Weight Watchers might be a great diet, and a diet that works, BUT IT IS A DIET.

Online members don't have to go to meetings. When I noticed my stall in weight loss, I asked for help on the message boards. "Journal everything," people said. One lady said she'd decided she would have to "give up" cream and sugar in her coffee. "I just made the decision that I really should limit myself. It's a better decision." Those were the kinds of decisions I'd have to make. I felt trapped again, but in a different way this time.


THE REALIZATION

Nickel-and-diming food is humiliating. It says, "You're too stupid to do this properly so you're going to be punished. You may have only X amount per day and you may not have any small things that you enjoy." It's also attractive--if you can only get yourself to swallow that line of bull, you can live up to the limitations you stick on yourself. Then you're a success. If you refuse to believe that you are a "bad person who needs punishment," then you're a failure. Catch-22.

Being in that "failure" state is depressing, even though you know you should be angry. It's horrible to see other people go through ridiculous self-limitation crap and lose weight. An overachieving anorexic type like me can't stand it, even though I know they'll gain it back the minute they stop hating themselves. Birthdays at work are awful. There's a cake, and people moan, groan, bitch about how they "shouldn't" have any cake. Or they sit off to one side and brag about how they're not having any cake because they shouldn't.

Last time I watched something that was funny and not funny at the same time. A woman moaned and groaned about cake. Then she took some cake, but she scraped the frosting off. Then she ate the frosting anyway about two minutes later. She kept moaning and groaning the whole time, as if the cake were physically hurting her.

The solution is so simple. I want to slap them all. I want to stand on the table and scream, "If you want cake, take some and enjoy it! If you aren't going to enjoy it then FOR THE LOVE OF ALL THE GODS, DON'T HAVE ANY!"

Maybe it's easy for me, because there are only a few kinds of cake that I like enough to eat and enjoy; I skip the kinds I don't like that much without regret. But I never tell the whole office about how I don't really like that kind of cake and it isn't worth the however-many calories when I have stuff I like better at home. I just wish they'd eat some or not eat some and keep quiet.

For about two years, I refrained from nickel-and-diming myself. I gained 12 pounds. All day long, every day, I played a tape in my head: You are a failure. You are fat. You are huge. And that alternated with a tape that said, why don't you start making a few positive changes. If you just skip a few things you'll be smaller than you are now. If you just, if you just...

And then one day a few months ago, I decided to make a truly positive change. The tapes were killing me. I turned both of them off. I went to Trader Joe's and bought cookies and candy--a LOT of cookies and candy. I bought a huge jar of peanut butter, an infamous "trigger food." That's a food that supposedly starts a binge. Lots of talk about those at Weight Watchers.

But I didn't binge, and now I know why: I'm not a binge eater unless I'm defying a diet. Nor am I an "emotional eater," stuffing down feelings with food: I'm an extrovert. I get my feelings out there right away; hanging onto them feels horrible.

No. I eat BECAUSE I CAN. Because there's nobody bothering me about what I'm eating, and I get back at those people who bothered me by saying "Look at me! I'm eating and there isn't ONE GODS-BE-DAMNED THING you can do about it, you big stupid jerks!" I eat to negate everything those people have said to me: mom, doctors, gym teachers, "concerned" friends. When I tried to argue with them to their faces, or call them on their insulting, humiliating behavior, they'd say they loved me (Mom) or were concerned about me (everyone else) and that's why they were doing it. I liked them; I trusted them; I couldn't say anything back that didn't sound like the all-encompassing "denial," which generates further self-righteousness disguised as pity disguised as "love" and "concern."

I was stuck. But not anymore.


THE FUTURE

This time, I filled the house with so-called binge food. But I didn't binge, because I have decided, finally, that what I eat isn't any of their business. I'm tired of playing the game. I'm making my own decisions, for myself, because I am a grownup and I like myself and I trust myself. I AM good enough--what I eat or don't eat doesn't have anything to do with that. I am smart enough to make my own decisions, as I always have been but I just couldn't see it because people I loved and trusted and respected kept telling me I couldn't control myself. But I can, I can, the minute they stop looking over my shoulder.

I'm done playing.

I like peanut butter. It took a few weeks to finish the jar, and then I bought another. I've barely touched the candy and stuff. I know that this time, I'm free. I might fall back into my old thinking, but at least I know what the trouble is. So no more crutches, no more crap. Just me.

Tuesday, October 17, 2006

EWHAED Salutes Dove

See Dove's website for an interesting look at the transformation from girl-next-door to billboard-ready.

And, if you haven't seen this commercial already, it's a good one.

Fashion Forward


In possibly the most drastic example yet of bringing the mountain to Mohammed, there appears to be a new trend in fashion (as reported by New York’s Metro newspaper)—women are having plastic surgery in order to wear the latest styles. As reporter Amber Ray notes, “skinny jeans are for skinny thighs,” and if you weren’t born with stick-thin gams, then after a quick procedure (en route to Bergdorf’s?), you, too, a la Audrey Hepburn, can bop around to “Back in Black” in the dark, tapered jeans introduced to the masses by The Gap.

The article quotes Dr. George Lefkovits: “‘What good is it to buy the latest designer pants if you still have the same body?’” It used to be that we chose clothing that flattered our physiques. In fact, almost every month, one fashion magazine or another will tell you what to choose—the perfect jeans (or swimsuit or dress) for your shape. Are you an apple or pear? Is your bust too big or too small? Legs too long or too short? Short-waisted? Hippy? Boyish? What is wrong with you? Because whatever it is, there’s likely an article of clothing that can obscure it. But now, the tide has changed, and it’s our bodies that are malleable in lieu of our wardrobe choices.

Still, Lefkovits argues that the ultimate goal of these procedures is not fashion-readiness, but creating a proportionate shape: “‘Regardless of what the fashion may be today or tomorrow, the body still has to be proportionate. So however fashion changes, the body will be ready for it.’” The mind (and the soul) may need some time to catch up. . . .

Thursday, October 12, 2006

The Thing About Research: Engendering Some Healthy Paranoia

People love to cite research. Take these fictitious examples: “This study showed that 80% of participants lost 10 or more pounds after taking these pills for one month.” “Another study showed that eating chocolate daily can lead to a long and painful death.” “Some research suggests that if you ingest fewer than 500 calories per day, you’ll live past 100.”

Let’s take a look at a real example: An AOL news item revealed recently that approximately 42% of French people (older than 15) have a “weight problem.” To start, the study was conducted by ObEpi-Roche, defined as a “drugs group” that “makes weight loss products,” such as Xenical. Hmm. . . think they might have a vested interest in showing exactly how fat the French are? How about the survey’s co-sponsors: Sanofi-Aventis and Abott Laboratoties (the manufactures of diet drugs Acomplia and Meridia, respectively)? The AOL article states that, “Campaigns were launched in France last year warning of the health dangers linked to obesity. . . .” It's always important to understand who is funding (either directly or indirectly) the research on obesity. In The Diet Myth, Paul Campos reports that many studies on obesity are conducted by physicians and weight-loss clinics intimately tied to the diet industry. By definition, this obfuscates the possibility of unbiased (read: ethical) research.

On August 27th, 2006, NBC exposed a similar problem in the cancer research arena. They revealed how cancer studies are often funded by pharmaceutical companies and that the drug companies play a large role in the research, often choosing what results will be reported and even writing the papers “authored” by scientists. That is, the researcher conducting the study doesn’t even write up the results (yet, his/her name is used for authorship). I’m concerned that researchers would allow ghost-writers to publish their results—as part of the American Psychological Association’s ethics code, for instance, I’m accountable to standards of practice that obligate me to, along with not publishing research that isn’t mine, avoid having sex with my patients! These are pretty big things.

Furthermore, many studies run multiple analyses as part of the research—in this way, researchers can get creative and choose to publish the results that support their hypotheses. . . and their products. As any amateur statistician can tell you, statistics are more an art than a science, and if you look hard enough (and run enough analyses), you’re bound to find something you hoped to see.

Next point: the study used BMI’s in order to define people as overweight or obese. Recent research has confirmed that the BMI is not an accurate and reliable indicator of weight-related health concerns. Should we still be using it as a measure? What measures do researchers employ in a study, and do instruments show adequate psychometric properties (i.e., are they valid and reliable)?

The informed consumer of research should consider other factors as well, when evaluating study claims. 1) How many participants were in the study? Generally, the more the better. Was it a diverse sample? Did the sample represent you? 2) Were all data used, and if not, how can we explain why certain data were tossed? 3) What types of statistical techniques were used? I won’t bore you here, but techniques can vary in their statistical power. 4) In a true experiment, were the participants and the researcher aware of the experimental hypotheses? If so, that may influence (and artificially inflate) the results. 5) How about that sneaky fellow, the placebo effect? 6) What other factors may contribute to what seems like a causal relationship described by study results? For example, let’s say one product (a diet pill) advertises itself to be proven effective for weight-loss in 90% of all patients. Let’s also say that taking said pill makes you really tired and you end up sleeping significantly more each night. Can we really say that the pill caused weight-loss? Or, did it maybe promote sleep, which on its own would have reduced food intake? Ever notice that (barring the Ambien-binge reports) you kind of eat less when you’re asleep? Insufficient sleep is also linked to disruptions in hunger hormones, such as leptin and ghrelin. Or, let’s look at happiness and exercise. If we find that people who exercise daily are happier, can we say that exercise leads to happiness? Not really. Maybe happy people are simply more inclined to hit the gym. 7) Where was the research published? Peer-review journals are best. Even research that’s really, really bad can be published in a sub-standard publication for a fee.

All kinds of factors need to be considered when evaluating weight-loss research. Unfortunately, the scientific value of studies is often obscured by the emotionality, funds, and media involved. Reading, and consequently citing, a study at face value is often not enough.

Tuesday, October 10, 2006

Velvet Aboveground

By now, you’ve probably heard about Velvet D'Amour, a 39-year-old model and actress who took Paris Fashion Week by storm. As part of his 30-year anniversary show, designer Jean-Paul Gaultier offered his unique spin on the recent Size-0 controversy in Spain (and in New York, where fall fashion week models were anecdotally judged to be more emaciated than ever before) by casting Velvet in his show. While the rest of his models donned workout gear (sweats, hoodies, etc.), Velvet, among a roaring crowd, pranced down the catwalk in a satin corset and negligee. None of this is really surprising, unless you’ve also heard about Velvet’s, um, weight. Reports indicate that voluptuous Velvet is 5’8”, weighs 291 pounds, and wears a Size 20 (see below). Velvet is decidedly plus-size.

By today’s standards, a plus-size model is defined as one who wears a dress size of 14 or higher (irony aficionados take note: that’s the average dress size of women in America). Emma Melissa Aronson is described as the first (barely) plus-sized model to gain widespread appeal. Really? Can you picture her? Funny thing about Emma—50% chance says she’s your size or smaller. But now, everyone seems to have a mental image of Velvet.

The model herself offers some perspective on the hoopla surrounding her recent job—Velvet’s quoted as saying: “If you tell me somebody's too thin, if you tell me somebody's too fat, you're still being prejudiced. The point is diversity.” That might not dampen the requisite backlash from those who haven’t gotten the point. In a New York Post article, Velvet is described as a “massive model” wearing a “barrel-sized corset and enough lace to outfit the entire Moulin Rouge.” A caption states: “The colossal catwalker at Jean Paul Gaultier’s Paris show looks as if she could swallow whole the stick-figure model [pictured next to her.]” Even removing the fat-is-bad lens from the equation, it’s still pretty far from praise. Hopefully, Velvet’s thick-skinned.

No one’s ever accused Gaultier of being subtle, but has he crossed the line, going overboard for publicity’s sake? Is Gaultier’s decision to use Velvet revolutionary, a pendulum-swinging act away from the disappearing model-star, or is she just the latest pawn in our global size wars?

Thursday, October 05, 2006

The War on Fat



New York City: The Big Apple. Land of opportunity. Food, everywhere you look. Come December, the city’s restaurant menu may be partially revamped. Last week, health department officials proposed a new code that would force the city’s 20,000 restaurants to limit their use of trans fats, the hydrogenated oils found in French fries, pies, and other processed goods. Establishments, including the city’s umpteen McDonald’s, would have to switch to oils and shortenings that have fewer than .5 grams of trans fat per serving.

Why the proposal? Artery-clogging trans-fats have been linked to heart disease. "New Yorkers are consuming a hazardous, artificial substance without their knowledge or consent," says Health Commissioner, Thomas Frieden. Earlier this year, the FDA began requiring food manufactures to list trans fat content on product labels. Now, New York City restaurateurs are up in arms, arguing that such a ban would affect the taste of menu items and would also drive up costs. New York, which banned smoking in restaurants in 2003, would be the first city to attack trans fats, though Chicago may soon follow suit.

Thoughts?

Tuesday, October 03, 2006

From the Mailbag

Hello Dr. Stacey,
While reading your blog EDNOS, I began to think about the roots of thin body expectations for women. Where did it come from? When and how did it evolve? When was it decided that thinner looked better? Certainly this is a phenomenon that has been around a relatively short amount of time, judging from photos and portraits of women considered beautiful over a hundred years ago. Perhaps you addressed this in earlier posts. I will peruse...

Also, what other cultures are so wrapped up in this obsession? Are eating disorders cross-cultural? What do eating disorders look like in other parts of the world? Do they only exist in developing nations? Of course, many parts of the world do not have enough food and don't have the luxury.

Sometimes I feel incredibly guilty and disgusting for having an eating disorder when I realize so many people don't have enough food to sustain their health. How dare I not eat healthy when others don't even have that choice. I am filled with self and culture-loathing. But then I realize that this thinking, while true, doesn't help me or anyone else. Self-love. Self-love. Self-love.

Thanks for your BLOG and thanks for reading,
Shelley

“Thinner is better” is a relatively new phenomenon, as we see from artwork and archival data. Looking at the sizes of models, movie stars, Miss America contestants, and even Playboy centerfolds, we see pretty sharp decreases in weight during the second half of the 20th century. Even our mannequins have shrunk—here’s some information I found: In 1950, the hip measurement for store mannequins was 34 inches, reflecting the size of the average woman at the time. Forty years later, when heroic chic descended on the catwalk, the average hip measurement for real women climbed to 37 inches, while mannequins’ hips shrunk to 31 inches. If these mannequins were real, they (along with Barbie, who if her measurements were extrapolated to “real” size, would be 6 feet and 101 pounds) would be amenorrheic. So, as real women have grown, our standards have gotten smaller, and as such, the frequency of dieting and eating disorders has increased.

To answer your second question, eating disorders are cross-cultural. Eating disorder inventories have been translated into countless languages and what we see are many studies documenting disorders among, for example, people of various cultures living in Western countries, as well as in women living around the world. That said, what’s interesting to note is that while women around the world may struggle with disordered eating, the relative incidence may vary, particularly when you take into account the culture’s exposure to Western ideals (see above). Some studies, for instance, show that when developing nations are introduced to Western media (i.e., they first get television access), the incidence of eating disorders increases. Anyone who has watched a couple of hours of Western-influenced television may understand why, both from the programming and commercials. From this, one can argue that eating disorders, to some extent, are culture-bound phenomena. Even with exposure to Western media, however, there is usually an accompanying predisposition—in Western countries, not everyone develops an eating disorder (with the same exposure), so a combination of variables is likely present. This describes what we call the diathesis-stress model—the diathesis is some sort of genetic, biological, or psychological disposition and the stress could be exposure to media, family dynamics, etc.

True, plenty of people around the world don’t have sufficient access to food. David Landes, author and professor of economics and history writes: “This world is divided roughly into three kinds of nations: those that spend lots of money to keep their weight down; those whose people eat to live; and those whose people don't know where their next meal is coming from.” While this provides some perspective, I’m not sure, as you indicate that it’s helpful to compare your struggle with others’, as that leads to greater self-reproach (which can fuel the problem). There will always be someone who suffers more than you—what matters, from my perspective, is that we do what we can to understand and support ourselves and that, if we’re so inclined, we reach out to others with fewer resources.