Tuesday, July 31, 2007

Book Review--Rethinking Thin

(It's on my sidebar as an EWHAED rec).

Just last week, I finished New York Times writer Gina Kolata's new book, Rethinking Thin. Kolata's served as a science journalist for The Times for almost 30 years, and has published a handful of books, including Flu: The Story of the Great Influenza Pandemic of 1918 and the Search for the Virus that Caused It and Ultimate Fitness: The Quest for Truth about Health and Exercise.

In Rethinking Thin, Kolata sets out on a similar quest for truth, this time concerning the diet industry and our societal obsession with (and relentless pursuit of) being thin. In the fashion of Paul Campos's The Diet Myth and Laura Fraser's Losing It, Kolata tackles head on the diet world, the concept of the obesity "epidemic," and the idea that dietary control may result in sustained weight-loss. A University of Pennsylvania study comparing two popular diets (low calorie vs. low carb) sets the backdrop for Kolata's historical account of how we've gained weight, lost it, and then, inexorably, gained it back.

You know the "willpower" argument--the mantra we hear almost daily that encourages us to keep trying harder to lose the weight? As Kolata writes, "Who could miss the drumbeat of messages from scientists and weight loss experts, the incessant hectoring year in and year out, assuring fat people that everything is possible for those who really, really try." Well, Kolata debunks that myth with support from the science of weight, highlighting the genetic influences associated with body type. She confronts the notion that fat people are to blame for their size, instead offering a literary montage of research studies suggesting we really don't have much control over what we weigh. It's a never-ending battle against our genes, and quite frequently, concerning our expectations, they simply just don't fit.

Kolata's account is cultural at times, referring to images of the Gibson girl, socio-political at others, documenting the negative correlation between obesity and socio-economic status, and even meticulously scientific, discussing hormones and chemicals, like neuropeptide Y and oxyntomodulin, suspected to relate to hunger and weight.

It's also sentimental--we follow the journey of four dieters in the university study, empathizing with their loftiest weight-loss hopes and dreams. Even Kolata, the objective science journalist gets drawn in by the diet allure, as she cheer leads the fateful four:

I wanted it so much that I began to suspend disbelief. I knew, I knew, the science and the overwhelmingly convincing evidence that most obese people will not be able to diet, get thin, and stay at a new low weight. But. . . I allowed myself to think that maybe, just maybe these people would make it. Maybe they would fulfill their dreams.

A whole science of obesity and weight loss seems be similarly hopeful, forever searching for the weight-loss holy grail. Kolata writes:

I'd often wondered how obesity researchers can keep doing study after study, advertising for subjects. . ., starting them off again and again on a path whose outcome they must know for sure. Could it be that the researchers too fall for the dieter's delusion?

Or, as Kolata notes, and as others have documented before her, can an entire industry rest on the possibility of autonomic weight control, be invested in studies and products that propagate this myth?

And, the assumption that fat is bad is similarly endowed with individual, institutional, and corporate backing. As Kolata points out, a lot of people have a lot to lose if we're to continue to show that being fat is not consistent with the dire health consequences the media and diet industry would like us to believe. In fact, publication of opposing studies is often displaced by those (which, incidentally, are often not as statistically sound as their counterparts) that champion the idea that if you are fat, you will die. Kolata states:

I'd like to think also that as the population gets fatter, there might be a rethinking of the risks of a few extra pounds. When health data have not supported the alarmist cries of a medical disaster in the making, could society perhaps let up on the beleaguered fat people.

Could we? We're so invested in some of these beliefs, challenging them would require a vigilant shift in focus, an active rebellion against the status quo, and a voracious curiosity and search for the truth behind the scenes. Kolata writes: "If nothing else, I believe that that research by scientists who have open minds about obesity and its causes and consequences is starting to open doors." With help from Kolata's exposé, we may eventually arrive at a place where the "age-old assumption that the perfect diet will somehow emerge" is as much a scientific blunder as the thought that the world was flat or the idealistic misconception that physical exercise should be effortless.

Thankfully, Kolata gives us a running start.

Tuesday, July 24, 2007

Shameless Self-Promotion

And now, a little bit more about me. . .

Who's the Hottest?

I'm sitting here with three of my favorite trade weeklies: In Touch, Us, OK magazines. Each has a feature where two celebrities are pitted against each other in similar frocks, titled, "Who Wore it Better?" Us actually compares three stars, modifying the superlative a bit to, "Who Wore it Best?"

See, the thing with these little contests is that I always get it wrong. I cover the winner (based on staff selection or reader polls), and I try to guess who, in fact, they chose. I study the images carefully--since, we're talking about clothing, I look at how the garment is tailored, shoe and accessory selection, fit, and even at the way the item falls on the celebrity's figure.

But, I almost always get it wrong.

Let me give you an example of why I think this is. Us Weekly's version (this is the July 2nd issue), compares three stars: Sofia Vergara, America Ferrara, and Tiffani Thiessen. Who do you think received the fewest number of votes?

Enough said.

OK's (July 16th) issue weighs Naomi Campbell against Beyonce. Again, guess who won?

My hunch is that it's really not so much about the clothing here, but about the celebrity's figure. I'd have to pour over the magazines' archives for this research project, but I'm guessing that the celebrity with the better body wins, regardless of her hem line, the clutch she carries, or the height of her heels. See, I think Beyonce has a rocking body, but a lot of people don't.

Usually, in my anecdotal research, it's the thinner celebrity, but not those we judge to cross the line. So, in In Touch's version, Eva Mendes actually triumphs over Bai Ling. Admittedly, I'm relieved when stars like Nicole and Paris and Victoria are not victorious.

I really wish we weren't putting these stars' bodies up for such scrutiny and competition. The guise of whose stylist assembled the better ensemble is simply too thinly veiled.

Wednesday, July 18, 2007

Music and Lyrics

During graduate school, some classmates and I were hanging out in the psychology graduate student lounge (a happening place, as you can imagine), and the subject of music came up--specifically, were we "lyrics" or "music" people? In other words, when you like a song, do you like it primarily because of its words or its beat? All of my classmates, given my attraction to the written word, figured I'd be a "lyrics" girl. Not so. So much of what attracts me to music is the beat, and often, I'm not even sure what the actual message is. Which bring me to the point of this post. . .

Recently, I was introduced to songster Mickey Avalon, and I've taken a liking to his work. (Right now you're probably think that I'm a 16-year-old boy--I assure you I am not). A couple of downloads later, I finally listened to the lyrics of one of the songs, "So Rich, So Pretty" (yes, I should have known) and was shocked to hear (and then look up) the lyrics below.

I liked the song. Now, I'm kinda mixed. Erase it from the play list?

Mickey Avalon - So Rich, So Pretty
I like a girl with caked up makeup.
In the sunshine, smoking cigarettes to pass the time.
Who wakes up to a bottle of wine
On the nightstand, bites and scratches the blinds.

But i ain't found one quite right yet.
So I step with pep to the park or supermarket it.
Her apartment best be messy.
And Lisa don't mind when i call her Leslie.

She's gotta dress with class.
In Jean Paul Gautier and an Hermes bag.
And 4 inch tips made of ostrich.
Sharp enough to slit your wrists, her lips spread gossip.
Won't say sorry when she offends.
She comes over to my place in her old man's Benz.
In gold and silver and jewels of all colors.
And she doesn't take them off when we're tearing up the covers.

Come on get it 'fore I change my mind.
Come on kid don't waste my time.
So rich, so pretty
The best piece of ass in this whole damn city.
So rich, so pretty.

I like a girl who eats and brings it up.
A sassy little frassy with bulimia.
Her best friend's a plastic surgeon.
and when her Beemers in the shop she rolls the Benz.
Manis and Pedis on Sundays and Wednesdays
Money from mommy, lovely in Versace.
Costly sprees it's on at Barneys.
And i love to watch her go thru 50 G's calmly.

She gets naughty with her pilate's body.
And thinks it's really funny when her nose goes bloody.
Cuz the blows so yummy and it keeps her tummy empty
And makes her act more friendly.
Dance the night away.
And she won't say nothing when she makes a man stray.

Come on get it 'fore I change my mind.
Come on kid don't waste my time.
So rich, so pretty
The best piece of ass in this whole damn city.

I've had you come before Mickey.
Go get my purse Mickey
Lock the door Mickey
You're just a midnight snack
Don't talk back.
You're just a boy Mickey.
You're just a toy Mickey.
You're just a boy Mickey.

Come on get it 'fore I change my mind.
Come on kid don't waste my time.
So rich, so pretty
The best piece of ass in this whole damn city.
So rich, so pretty.
So rich, so pretty.
The best piece of ass in this whole damn city.

Thursday, July 12, 2007

The Mutual Admiration Society

A couple of days ago, I received an email from Leslie Goldman, author of The Locker Room Diaries (check out my side bar for the Amazon link). Goldman was writing to compliment me on this site and my writing and to suggest that we somehow collaborate in the future. Wait--the woman, whose book rests proudly among my other e.d. reads, was contacting me, saying she liked MY writing?


So, stay tuned for some type of LRD/EWHAED venture. In the meantime, check out Goldman's iVillage blog. Her writing's funny, poignant, and EWHAED approved!

Tuesday, July 10, 2007

You'll Never Have to Exercise Again

Well, at least that's what the headlines will soon lead you to believe. . .

Salk Institute scientists recently created an "exercise pill," activating a gene that results in cellular fat burning. Mice who were given the formula failed to gain weight, via chemical activation of PPAR-d, a fat-burning gene, even when fed a high fat diet.

Of course, our interest in mice only extends to how research might apply to us; researchers are suggesting these findings might warrant new ways of addressing human metabolic concerns.

So, exercise no more? Even if the pill is to be proven safe and effective with humans, the only demonstrated benefit (at least with mice) is increased cellular fat burning. That leaves a whole host of physiological and psychological benefits of exercise untouched.

Back to the treadmill it is. . .

Thursday, July 05, 2007

We Pause for this Important Message

Today, I'm tired of writing about eating disorders, (aren't you sick of reading about them?), so I'll focus on another issue, our nation's health care system, my diatribe inspired and fueled by my recent viewing of Sicko, Michael Moore's new flick. If you have any interest in health care, check it out--if nothing else, Moore's acerbic wit is sure to entertain. I actually found myself laughing out loud at a scene in which a woman, who had been in an accident, reported that the payment for her emergency transportation to the hospital was denied because she had failed to have the ambulance ride pre-authorized. It's funny. But it's not.

As both a patient and a provider, I've struggled with managed care. I've found myself wondering what universal health care would look like in the States, why we can't seem to get it right. Applying for Medicaid, which is supposed to insure even the most economically disadvantaged, isn't the easiest process to navigate. And, once you have Medicaid coverage, you don't get much besides the card. Most providers, at least in mental health, don't even accept Medicaid, and at horrendous reimbursement rates, that make a mockery of their advanced degrees, why would they?

Several years ago, I did a brief stint at a city hospital, where most of the patients were covered by Medicaid. My stint was brief because on my first day on the job, I was assigned 103 patients--any idea what a typical therapist's case load is like? Not 103 patients.

The objective was to meet with 10 patients a day, for 30 minutes each. Now, in the managed care and private pay worlds, patients are entitled to a bit more time. Not these folks. And, the frequency of therapy? Because of my 40-hour work week and various administrative demands, I was instructed to see each patient once every three to four weeks. Not the most ethical or medically sound care, given that many of the patients had major mood and/or psychotic disorders. Each patient in my case load required volumes of paperwork--I took to, and I'm embarrassed to say this, completing the paperwork in session, because it was the only way to get it done. For many, I was their third or fourth therapist in the last few months, due to incredibly high turnover rates.

In addition to the clinical overload, the work environment was, to put it mildly, sub-par. It took way too long to get my office up and running. My phone didn't work--not even a dial tone. So, I went downstairs to the telecom department, which was conveniently located next to the morgue, and spoke to Ms. Telecom about the problem. "My phone doesn't work. No dial tone, " I said. She handed me a slip of paper. "Here, call this number."

My computer, as luck would have it, didn't work, either. I went to I.T. They also gave me a number to call. Or, if I'd rather, they mentioned, I could log on to their trouble-shooting site. Every exchange, every moment at this hosptial, felt just like this.

Pretty soon into my stay, knowing that I would leave shortly, I visited the H.R. department to inquire about health insurance coverage. "I'm curious how long you have to work here in order for you to qualify for COBRA?", I asked. And, the director of benefits, housed in the hospital's H.R. department responded, "What's COBRA?" He also engaged me in a casual conversation regarding his recent vacation and his concern that there had been some Arab travelers aboard his flight. "You should be suspicious of the Arabs," he said. I quickly thought, "You should be suspicious of those who tell you to be suspicious of the Arabs."

So, who would work at facility with dysfunctional technology (and office clerks), dusty, likely asbestos-rich walls, and racist, incompetent H.R. staff? Let me tell you about my colleagues, each caricatures of a sort: One of the psychiatrists seemed to have some trouble reading social cues. Whenever he spoke to me, he never made eye contact, and I was always left wondering if he was talking to me or himself. One day, he said something to me in passing in the hallway. I had thought we were done, so I continued walking, but he kept talking, unfazed by my departure.

A social worker down the hall wore a white coat to work each day, as if he were an M.D. I asked him about it once, and he reported that many social workers wear white coats. No they don't. That's great, I thought to myself, there's a therapist with a delusional disorder working down the hall.

And our fearless leader? The clinic director, a psychiatrist, stood up at a staff meeting one day and stated how difficult it was for him to be the most intelligent person in the room. I'm not kidding. He's also the person who told me my first week, "If you and I get along, you should have no problems here," who referred to our clerical staff as "stupid" (yes, to their faces!), and encouraged his providers to commit Medicaid fraud. According to information gleaned after my departure, a thick enough H.R. file eventually resulted in the discipline of said psychiatrist. He was only kept on board with the provision that he must always have a third person present for his one-on-one conversations. He was castrated, but still allowed to screw.

Clinical care was substandard, morale was atrocious, and the building was falling apart. Can you see why I left? But, the thing is, this is the care that countless of Americans get. They wait hours and hours for appointments (one patient arrived for his scheduled 11 a.m. appointment at 8:30 am. because he was so accustomed to having to wait) to see providers who are overworked, mistreated, and not provided with the appropriate resources and administrative support they need to do their jobs. . . who then leave, despite their best intentions to make the world, or at least Manhattan, a better place, after just three whirlwind months. I wonder how, if we were to insure every American (and without extraordinary tax hikes), this scenario could be different, where folks who needed medical care could actually get it and not just instigate a paperwork trail that made it look as if they did.

(Apologies for the non-eating-disorder rant. Regularly scheduled programming will resume next week.)