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.

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?

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?

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.

Magazine Article

See here for an interesting article on celebrities and eating/body image, courtesy of People magazine.

Irony

Toward the end of World War II, a biologist by the name of Dr. Ancel Keys set out to determine some of the physiological and psychological effects of restricted food intake in what was known as “the Minnesota starvation study.” The motive, it seems, was to understand the mechanisms of starvation, in order to more adequately handle potential post-war, European famine. The study participants were 36 physically and psychologically healthy men, conscientious objectors to the war, who volunteered to participate in a diet-regimen that cut their normal caloric intake roughly in half for a period of six months. What followed was an unprecedented look into the science and psychology of malnutrition. (One participant, Lester Glick, chronicles some of his experiences here.)

As any observer of the Jewish holiday, Yom Kippur, or the Muslim period of Ramadan may tell you, fasting is a unique psychophysiological state, in which food becomes a primary focus. While religious or spiritual matters may be intended to take center stage, when told to not think about a white horse (or White Castle burger, as the case may be), that’s exactly what we can’t seem to do. Fasters may overindulge the night before, as they “stock up” for the fast, may similarly overindulge post-fast, and often report spending a great deal of time during the fast thinking about food, their hunger, and when they’ll eat again. From a dieting perspective, it’s likely that in the end, they’ve consumed more food than they would have without the fast, with the additional problem of having toyed (albeit briefly) with their metabolism.

In the Minnesota study, now captured by Todd Tucker in the new book, The Great Starvation Experiment, what we saw was a compromised humanity (and throwback to animal times), resulting from food restriction. As participants lost weight, and essentially began to starve, not only did they become incredibly and solely focused on food, but their hunger took on epic proportions—participants reported violent fantasies, contemplating suicide, murder, and ultimately, cannibalism.

A hot topic lately has been the significant increase in adult (and childhood) obesity—recent figures indicate, for example, that 64% of Americans (115 million) are considered overweight or obese. How do we explain this trend? While a number of factors may be involved, taking note from the Minnesota study, as well as the general research suggesting that (depending on which study you reference), 95-98% of all diets fail, it seems that perhaps the simple and repeated act of trying to restrict oneself has actually led to our expanding waistline. Trying to (unnaturally) tame an appetite can have quite a rebound effect, leading to both acute and chronic overeating, as compensation. While most self-imposed food restrictors thankfully do not arrive at the point of suicidal or homicidal ideation, what we can say is that the more weight we try to lose, the more we seem to gain. As a corollary, the more we grow our diet industry (now worth an estimated $40 billion), the more we grow ourselves, begging the question: Is it possible that we are obese simply because we are trying so hard not to be?

Miss Jackson

Janet Jackson. Amid wardrobe malfunctions and family drama, the woman still knows how to pick a man. In a recent issue of Britain’s Grazia magazine, Janet reports that despite her 68-pound weight-gain for a now defunct movie role, her music industry boyfriend, Jermaine Dupri, still worshipped her frame:

Not once did he make me feel uncomfortable. He'd grab me, pull me around the stomach, look me in the eyes and say, 'This needs love too!'

I thought that was the sweetest thing. I've never in my life had love that was so unconditional.

My weight never affected my sex life. Nothing changed, nothing!

40-year-old Janet is convinced she’s found “The One.” To know that while her weight may fluctuate, his attraction to (and love for) her remains constant produces one of the most monumental relationship exhales. And, isn’t that what partnership is all about? To quote Janet in song, “That’s the way love goes.”

Medifast Response

My August 29th post on Medifast appears to have hit a nerve. While I typically haven't commented on older posts, I feel it's important to address some of the reader comments that now appear on this post.

I am happy to hear that some readers have lost significant amounts of weight on Medifast and even happier that they report being healthier and feeling more energetic than they did before. I have consistently written that the subjects of eating and weight-loss are largely idiographic, and it makes perfect sense that different philosophies/approaches will work for different people. If Medifast has worked for you, feel free to stop reading here.

That said, as I wrote in an email to one reader, my personal experience working with patients (some of whom have had bariatric surgery, some of whom have clinical eating disorders, many of whom use food emotionally) is that there is very commonly a long and painful road of yo-yo dieting, which wreaks significant emotional havoc on them. By the time they see me (or my colleagues), they have tried numerous diets (some VLCD's), have lost weight, gained it back (plus some), and are absolutely dejected and demoralized. Through the years, I have also seen many patients who suffer from anorexia, bulimia, and EDNOS. This is the bulk of the readership of my blog (as judged by comments and emails to me). For these individuals, too, their relationship with food is an incredibly deep and emotional one and not one that can be addressed simply with a food plan or other behavioral measures. This does not, in any way, suggest that I believe that people cannot lose weight on Medifast. As some of you have reported, there is often a substantial weight-loss associated with VLCD's--and how could there not be?

To clarify a point on my post, I was not saying that Medifast allows only 167 calories per day. What I was saying is that in order to lose five pounds per week (as the Medifast website states is possible with the plan), you would have to have a deficit of 17,500 calories per week. You do the math. I have consulted with physicians and nutritionists on diets such as Medifast. As with everything, there are varying points of view. I will not, however, accept a doctor's approval of a diet plan as carte blanche to plow ahead. If you recall, Bextra/Vioxx/Celebrex, Fen-Phen, and even Thalidomide were once approved for use.

A couple of readers have questioned my credentials: I am a psychologist, with a master's degree in exercise science and a doctorate in clinical psychology (with an emphasis on health psychology). You're absolutely right that, outside of what's provided to me by the physicians and nutritionists with whom I consult, I do not claim to have specialized knowledge of specific nutritional programs. What I do claim to have knowledge and training in (and experience with) are the psychological factors that influence eating, dieting, and weight-loss cycles. In my experience, programs like Medifast are not a long-term solution to the psychological antecedents and sequelae of eating disorders. They may, however, work for you.

I do appreciate controversy. Without different (and often opposing) ideas, it is difficult for us to move forward as a science and a society. Attack my ideas as much as you'd like--I'm happy to provide a forum for you to do so; however, please, as I have advised before, challenge the ideas and not the writers. When attacks become personal, they are unnecessarily hurtful and obscuring of our ultimate goal.

Miss Scarlett in the Kitchen with the Wrench

In an In Touch magazine feature entitled, “I Won’t Starve Myself,” Scarlett Johannson reports, “‘I’m comfortable with my body.’” Aside from the obvious question (who wouldn’t be comfortable with Johansson’s body?), I’m happy to read such a body-positive statement, particularly from a star who hasn’t historically made the “skinny alert” reports. “‘I’m not one of those actresses who is going to stop eating. . . I like chocolate and I’m going to eat it!’”, Johansson says.

She seems to have arrived at a place that allows her to recognize her body is a factor in her work, but one that allows her to engage in healthy eating and body image practices. In a recent People feature, Johansson states: "I'm curvy – I'm never going to be 5' 11" and 120 pounds," she says. "But I feel lucky to have what I've got."

Johansson is currently parlaying her body positivism into the design of a new line for Reebok footwear and apparel, called “Scarlett Hearts Reebok.” The line, which debuts in the spring of 2007, has been described as “athletic inspired” and “fashion forward.” Johansson tells InStyle magazine that items are "fitted to my body. So I know they'll fit a regular person." Well, Scarlett, you’re not exactly a regular person, but you’re certainly a closer approximation than the waif. Every Woman Has an Eating Disorder hearts you for throwing a wrench in the celebrity culture of starvation and body distortion and for eating what you want and accepting yourself the way you are.

Pathways

In Overcoming Binge Eating, Dr. Christopher Fairburn describes a common pathway for how patients arrive at bulimic behavior:

Typically the person begins dieting and losing weight in the mid-teenage years, despite in many cases not having been overweight in the first place. When the weight loss is extreme, it leads to the development of anorexia nervosa. Eventually, after a varying amount of time, the person’s control over eating starts to break down and he or she begins to binge. Control progressively deteriorates, and the person’s weight gradually returns to near its original level.

Once bingeing begins, it may only be a matter of time before the fear of weight-gain escalates to the point of necessitating the purge.

Sound familiar?

Of course, anorexia is not a required stop in this journey—many people swing from dieting to binge eating without a descent into full-blown anorexia. In either case, one of the easiest points of intervention in this dieting-->anorexia (or not)-->binge eating-->bulimia cycle is the dieting stage. Dr. Fairburn talks about three forms of dieting, including:

1) Trying not to eat for long periods of time 2) Trying to restrict the overall amount eaten 3) Trying to avoid certain types of food

According to him, any of these restrictions can eventually lead to a binge. What I find interesting is how creative we are with our dieting attempts—we may think we’re not dieting because we’re not on a specific plan or because we eat three meals a day, but when you consider the restrictions above, it’s clear how the diet can cleverly masquerade as “I’m too busy to eat” or “I’m just being healthy.” Will dieting always segue into an eating disorder? No. But, for many it will, and it’s important to be aware of this outcome and to be on guard for the plunge into anorexic or binge-eating behavior.

Community

So, this is it—my 101st post! I still plan on posting regularly (aiming for twice a week), though will now turn more of my attention back to my clinical work, teaching, and getting this book proposal accepted.

For now, I’ve compiled (a la Barbara’s idea) a list of the blogs I know that link to me. Apologies if I got any of the addresses wrong—please feel free to correct or redirect in the comments section. Also, if you link to me but I don’t know it, please feel free to add your site. Thank you all for sending readers my way. Everyone else—check out these amazing blogs and the women who write them!

www.aweightyissue.blogsome.com
www.babblingcats2.blogspot.com
www.bexactually.blogspot.com
www.burntoday.com
www.cheatymonkey.com
www.dickundduenn.blogspot.com
www.donnainhouston.blogspot.com
www.fatnforty.wordpress.com
www.girladdicted.com
www.hollygoheavily.blogspot.com
www.idiet.blogspot.com
www.iendedupherehow.com
www.jens-ramblings.blogspot.com
www.kellyim10.blogspot.com
www.meltingmama.typepad.com
www.minusthirty.blogspot.com
www.nopenotanymore.blogspot.com
www.nourishyoursoul.blogspot.com
www.onbulimia.blogs.com
www.onceuponafatgirl.blogspot.com
www.opaat.blogspot.com
www.pathofmindfulness.blogspot.com
www.sizeate.blogspot.com
www.talesofafatgirl.blogspot.com
www.thechocholatebunny.blogspot.com
www.weightedlongenough.com

Motivation

Do you operate out of self-love or self-abuse? It’s something to consider, especially if you’d like to change something about yourself. I’d argue that no change can be made out of self-abuse. The self-loving part of you will always step in and sabotage the plan.

A big push in psychology (particularly with regard to eating disorders) is this concept of self-care. How do you comfort, soothe, and be kind to yourself? Are you compassionate, gentle, and patient, or harsh, punitive, and unyielding? What language do you use with yourself? Is it angry, hurtful, and condemning?

As someone who usually espouses the value of the continuum, I’m feeling pretty black-and-white on this one. It seems that so much of our behavior, particularly related to eating and our bodies, is either motivated by self-care or self-abuse. Eating when you’re hungry? Self-care. Exercising when you’re tired, or sick, or because you have to get rid of the fat? Self-abuse. Allowing yourself to have a food that you desire? Self-care. Eating when you’re stuffed? Self-abuse.

Making Weight

Dislike your job? It could be worse—The New York Post reported yesterday that two ex-waitresses of Manhattan’s Sutton Place Bar and Restaurant are suing the establishment (to the tune of $15 million) for tracking their weight and forcing them to hop on the scale at work. One of the plaintiffs, Kristen McRemond, 27, indicated that “she physically resisted when a beefy manager tried to pick her up to get her on the scale while another manager looked on.” It seems that only female employees were subjected to public weigh-ins (or criticized for their choice of foods when dining themselves). The Post reports that the “waitresses' individual weights were tracked on a computer spreadsheet - and the results placed on a Web site that tracked the weights of waitresses in other establishments in the city.”

McRemond, and her co-plaintiff, Alexandria Lipton, 25 (featured above), are accusing Sutton Place’s owners and managers of sexual harassment and illegal firing—both McRedmond and Lipton were axed after vocalizing disagreement about the weigh-ins. As you may imagine, the restaurant’s lawyer has denied these allegations, but has not provided explanation as to why McRemond and Lipton were let go.

While the allegations here are pretty straightforward, it begs the question of how many other workplaces engage in less-subtle (but still discriminatory) weight-related practices. I hope that the current suit raises consciousness about weight discrimination, particularly against women. A woman’s body is not a commodity, a product to be sold—and if the owners of this establishment disagree, then, clearly, they’re in the wrong business.

EDNOS

Eating Disorder Not Otherwise Specified (EDNOS) is a clinical eating disorder that captures eating-disordered thoughts, feelings, and behavior that do not meet full criteria for Anorexia Nervosa or Bulimia Nervosa. While no specific criteria distinguish this diagnosis, the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM IV-TR) offers the following examples of symptoms that would warrant a clinical diagnosis:

1. For females, all of the criteria for Anorexia Nervosa are met except that the individual has regular menses.
2. All of the criteria for Anorexia Nervosa are met except that, despite significant weight loss, the individual’s current weight is in the normal range.
3. All of the criteria for Bulimia Nervosa are met except that the binge eating and inappropriate compensatory mechanisms occur at a frequency of less than twice a week or for a duration of less than three months.
4. The regular use of inappropriate compensatory behavior by an individual of normal body weight after eating small amounts of food (e.g., self-induced vomiting after the consumption of two cookies).
5. Repeatedly chewing and spitting out, but not swallowing, large amounts of food.
6. Binge-eating disorder: recurrent episodes of binge eating in the absence of the regularly use of inappropriate compensatory behaviors characteristic of Bulimia Nervosa.

DrStaceyny’s input (by number):
1. One of the required symptoms for a diagnosis of anorexia is that you present with amenorrhea (having no menstrual period for at least three months). So, if you meet all other criteria for anorexia (less than or equal to 85% of what you should weigh, fears of gaining weight, body-image disturbance), but are still getting your period, your diagnosis would likely be EDNOS.
2. The first criterion for anorexia is “refusal to maintain body weight at or above a minimally normal weight for age and height.” This is often translated to the 85% rule stated above. However, some people might have started out at a heavier weight, and thus, even if they lose lots of weight, they’re actually not below “normal” weight expectations.
3. Think of this one as less-frequent bulimia—there is bingeing and purging, but not at the same rate (or for the same duration) as what would be required for a bulimia diagnosis.
4. This example captures those who don’t, by definition, binge, but who still rely on compensatory strategies (vomiting, laxative use) following even small amounts of food consumption (sometimes referred to as “purging disorder”).
5. Pretty straight-forward.
6. Binge Eating Disorder is, as of now, what’s called a “criteria set.” The American Psychiatric Association has recognized the condition as one which warrants further empirical attention, and it’s quite possible, that by the next revision of the DSM (supposedly in 2010), Binge Eating Disorder will be recognized as its own diagnosable (read: reimbursable) condition. Other disorders similarly on deck include: Premenstrual Dysphoric Disorder (now coded under a type of depression), Mixed Anxiety-Depressive Disorder, and Caffeine Withdrawal.

The list of six examples given above is not intended to be a comprehensive list of all of the symptom constellations that might qualify as EDNOS. Symptom presentations, as individual, may vary, and it is important to recognize that for those who suffer from EDNOS, this is a serious condition no less painful, no less subjectively detrimental, no less of a personal hell than anorexia or bulimia. While it is likely that EDNOS is not as fatal as anorexia or bulimia, EDNOS can still cause substantial ruin. EDNOS can ruin your self-concept. It can ruin relationships. It can ruin your work and your interests. It can still ruin. . . you.

Score One for the Home Team

The rain in Spain falls mainly on the plain—well, not anymore, because (tiny) curves are in in Madrid! AOL News* reports that Spain’s hottest fashion show, Pasarela Cibeles, forbade a number of models from participating this year. . . because they were, oops, too thin. In a surprising example of how Body Mass Indexes can be an effective and reliable health/wellness tool after all, pageant officials calculated models’ indices and dropped each hopeful with a BMI shy of 18.

The show, which features primarily Spanish designers, decided to enact this measure following the aftermath of last year’s show, which featured “bone thin” models. Aghast feminists and medical professionals spoke up, recognizing how parading these forms on the catwalk can fuel national eating-disordered behavior, particularly among young girls. The decision to step in seems to be a collaborative effort of Madrid’s regional government and the Association of Fashion Designers of Spain. AOL readers, it seems, would likely offer their support, as well. In an on-line poll of over 55,000 voters (when I voted), 91% believed that the presence of “ultra-thin” models contributed to the development of eating disorders.

As New York City launches its fall fashion week, I wonder if the U.S. (and other countries) will follow in the Spaniards’ footsteps. After hearing the news, Ryan Brown, of the Elite Modeling Agency in New York, is quoted as saying: “I think it is great to promote health.” Time will tell how many fashion weeks will come and go before such a sentiment is turned into practice on American soil. As for now, Brown notes: “They don't want voluptuous girls any more,” though he adds: “It would be nice if fashion got back to that.” Yes, Mr. Brown, it would.

*thanks to the readers who sent this my way

Google Me This

Coming up on my last week of daily posts, I thought it would be interesting to explore how people found my blog, since when I started out, I only shared the site with a handful of colleagues, family, and friends. As such, I’ve been periodically tracking the Google searches that have landed readers here. Many of them relate to celebrity diet/weight concerns:

-Is Mandy Moore getting fat?
-Beyonce Knowles’ recent weight-loss secret
-Katherine Heigl bra size
-Jessica Alba eating disorder squats
-Jamie Sigler eating disorder
-Katie Couric fat arms

We also seem to be very interested in celebrity dress sizes, including the sizes of some of the aforementioned stars, as well as others.

One of the more popular searches that lands people at my site?

-Woman eating shit

So. . . uh. . . I have absolutely no idea what to say here.

Other searches focus on dieting and eating-disorder tips and techniques:

-What WW members eat
-Non-purging bulimia
-Starve and barf
-Bingeing restrictions
-How to hide an eating disorder

In fact, many are of the pro-ana/pro-mia variety. I can’t even count the number of searches for these terms. I also can’t imagine the disappointment in trying to find a pro-ana site and getting stuck with me. We seem, overall, to be very interested in anorexia and the disappearance of flesh.

-Anorexic 75-lb woman
-Freudian anorexic pregnancy
-Ballerina anorexic images
-47-pound anorexic ballerina
-Anorexic role models

And, the most harrowing query to date?

-How little can a woman weigh and still live

Parenting

A recent study conducted by Boston University’s School of Medicine, and appearing in the June issue of Pediatrics, revealed that children of authoritarian (strict disciplinarian) parents are five times more likely to be overweight by the first grade than those reared by more authoritative (democratic) parents. True, children of overly permissive and/or neglectful parents were even more likely to be overweight, but the question remains—why would kids raised by overly strict parents tend to be more overweight than those exposed to more flexible parenting?

The study’s lead author, Dr. Kyung Rhee, provides some clarity, suggesting that authoritarian parents may inhibit children from developing their self-regulatory abilities. Children instructed to eat brussel sprouts, for instance, instead of vegetables more palatable to them, lose their sense of autonomy and personal choice, which may, in turn, affect their abilities to “listen to their bodies about how full they are,” Rhee says.

Another factor, I’d add, is that children of excessively strict parents may soothe themselves with food in an effort to comfort themselves following (or preceding) frequent disciplining. Moreover, in a system where rigidity is key, children may rebel by overeating, sneaking food as an effort toward self-expression and/or separation from the family.

My Time in the Zone

The story, of which I have no recollection, goes something like this: When I was five, my mother served hamburgers one night for dinner. Always inquisitive, I posed a question to her: “Mommy, how does the cow make the hamburger?” My mother, not wanting to mislead me, replied, “Stacey, this is the cow.” I pushed my plate away.

While I did go on to eat meat again, fast forward about twelve years, and, fueled by burgeoning ideas about animal ethics, as well as a general unrest about chewing animal flesh, I became a full-fledged vegetarian.

A few months before beginning this book, I went on my first organized diet. I wasn’t really trying to lose weight (ok, maybe a few pounds), but was more interested in healthy eating and balancing protein and carbs, as the media told me I should be doing. As a vegetarian, I’m often asked, “Do you get enough protein?” Truth is, I’m not sure I do.

One of the Zone-Diet inspired plans had recently unveiled a vegetarian program, so I decided to give it a go. My go involved about eight servings of tofu a day. I had tofu for breakfast, lunch, and dinner, and tofu before bed. As I write this, I stand firm (though, not extra firm) in my belief that tofu is not a breakfast food, no matter how closely it resembles a sausage link.

During my trial, I’m really, really hungry and am not sure they figured in my active lifestyle when calculating my portion sizes. A couple of days into the program, I go to the gym and realize my effort is about 50%. I’m tired, and can’t run far. The next time I try to run, I’m even more exhausted. I barely make it home from the gym, dizzy, faint, and unsure of what to do. My normal blood pressure is 90/60, and I can tell I’m south of that. I consider going to the closest E.R. Meanwhile, I plant myself at the computer, and search the panacea for all things medical, the web, where I learn that such diets (particularly for the uninitiated) often create electrolyte imbalances and that salt ingestion is a quick and effective cure. I grab some crackers and slowly begin to feel better, more myself. I toss the remaining meals, feeling slightly rebellious, but healthy and liberated. About a week later, I get a call from a program rep, who asks me how the diet went. I explain how hungry and tired and sick I became, detailing my near emergency-room excursion. His response: “I’m sorry to hear that. We’re offering a discount for the monthly program, which would be only $36.95 a day. Would you like to enroll?”

Gambling on Life

The Hollywood Gossip is a celebrity site that devotes an entire category of posts to eating-disorder gossip. On the site, recently, I found this poll:

Which emaciated star will disappear first?
1) Nicole Richie
2) Kate Bosworth
3) Mischa Barton
4) Paris Hilton
5) Ashlee Simpson

Games: Simon Says, Monopoly, Spades
Not Games: Taking bids on people’s lives

Body Innocence

A while back, I posed the question, “How far back do you have to go to arrive at a time when you weren’t aware of your body?” To frame the question differently, I’m curious when we lose, what I call, our “body innocence.” Body innocence has to do with knowing what your body can do, knowing what you look like, but not being “aware” of your body—not judging your appearance, not worrying about what you’re eating, not checking yourself in the mirror, or weighing yourself repeatedly. Body innocence is accompanied by cognitive innocence of all things diet and weight-related. Becoming body aware (versus innocent) does not necessarily lead to an eating disorder; however, this is often the first step down a windy, insidious path.

What causes us to lose our body innocence? A starting, and certainly not comprehensive, list:
1) An unsuspecting comment by a family member, friend, or peer
2) A purposely cruel comment by a family member, friend, or peer
3) Losing some weight unintentionally and being consequently reinforced by
others
4) Realizing ourselves that we’re not as skinny as other children
5) Being involved in a weight-dependent activity, such as ballet, gymnastics,
cheerleading, or ice skating (let’s not even say, “figure skating”)
6) Exposure to constant media messages about unnaturally thin celebrities
7) Exposure to constant media messages about the dangers of being
overweight
8) Exposure to constant media messages that promote diet pills, plans, and procedures
9) Exposure to family members, friends, or peers, who aren’t body innocent
10) Abuse

Lose 20 Pounds Fast!

By now, you’ve probably heard about Katie Couric’s twenty-pound weight loss. It seems that CBS promotional magazine Watch! Photoshopped, without Couric’s awareness, a recent shot of the anchor-to-be, resulting in a cinched waist, contoured cheekbones, a smaller bust, and thinner arms and hips.

Couric’s response, according to The Daily News: "I liked the first picture better because there's more of me to love." And, really, don’t you just love her more after a comment like this? That’s what the polls say, after all. According to People magazine’s online pole, 54% of us prefer the untouched shot. In other words, we prefer Katie with a little meat on her bones.

Or, do we? Perhaps we like the natural shot because we know it’s natural. It’s the cutesy, girl-next-door we’ve grown to adore. Are we really immune to societal messages that thinner is better? Given pictures of two women who look alike, wouldn’t most, as any advertisering exec would tell you, judge the thinner one to be more attractive? Which do you prefer?

You Could Learn a Lot from a Puppet

Cookie Monster seems to have it down. The newly appointed healthy-foods ambassador (a cookie is a “sometimes food”) offers a good example of mindful eating. A recent issue of Metro (a New York daily) features an interview with the furry, blue, cookie-loving puppet.

Cookie Monster instructs us how to eat a cookie:

You got to eat cookies like this: You pick up the cookie. Look at it. You smell the cookie. It smell delicious usually and then you just go for it like this: AHHMNUMNUMNUMNUMNUM. The more crumbs, the better. Me teach you how to eat cookie professional way.

His message is funny, and grammatically questionable (in classic Cookie Monster style), but highlights some critical features of intuitive eating—allowing yourself to indulge in what you enjoy and making eating a complete sensory experience.

When asked about variety in his diet, Cookie Monster reports: “Me no ever only ate cookies. Me eat everything. Me eat you know, bicycle, fire hydrant, table, chair. Me love cookies but me also eat vegetables.”

Everything in moderation. . .

Product Review: Say Goodbye to Hunger?

The Medifast Diet keeps popping up on my computer, begging me to take a look. Finally, I acquiesce. I’m invited to try a diet that eliminates decisions, freeing me from the calorie- and carb-counting I’m presumed to do on a daily basis. The solution? They count for me, and I get roughly four. . . of each.

The program consists of five Medifast meals per day, accompanied by one “Lean and Green” meal (“lean protein and salad greens”). The Medifast website states: "The clinically proven results of Medifast are designed to create a healthy gap between the calories you take in and the amount your body burns, thus promoting natural weight loss." According to my calculations, and based on the roughly 3,500 caloric-deficit needed for a pound of weight-loss, that’s a “gap” of 2,333 calories a day. If you were eating 2,500 calories a day (and maintaining your weight at that figure), you’ll now eat 167. I don’t see any program-recommended exercise, except for that suggested during the post-diet, “weight-maintenance” stage. In fact, the website states that, “Unless you are already exercising, you should not begin an exercise program in the first few weeks of weight loss.” Clearly, with a deficit of 2,333 calories a day, you’re not going to be able to run that far.

The website advertises that “Medifast programs have been recommended by over 15,000 physicians.” What physicians are recommended this program, given that most people in-the-know do not recommend more than a 1-2 pound weight-loss per week (and this is up to 5)? I also wonder what kind of chemicals, fillers, and multisyllabic ingredients they’re passing off as a meal (the site indicates that most products use “acesulfame potassium” as a sweetener).

The copy promises you’ll never get hungry. That "fast" is part of the product name doesn't bode well for you feeling satisfied. And, anyway, how is this even possible? If you’re eating 2,333 calories per day less than you’re burning, I’d think you’d be hungry! And so do they, to some extent: The FAQ’s page encourages users to take an antacid to deal with persistent hunger pains. Other potential side effects they list? Diarrhea, gurgling stomach cramps, constipation, bad breath, feeling cold, skin rashes, heartburn, and hair loss. All this for short-term weight-loss. After all, even the Medifast people recognize the difficulty of keeping off weight, once you’ve completed the program. The site states:

You will maintain your success by making long-term changes in your lifestyle such as healthy eating and consistent exercise. You may also need to work on how you cope with life so that you don't reach for food when you are experiencing stress, depression or other emotional needs.

If you could do all this, you wouldn’t be turning to Medifast in the first
place. . . .

An Afternoon in a Coffee Shop

I’m sitting at a coffee shop this weekend, working on this book. A few people wander behind me, and I’m half-listening to their conversation as I write. One of the women asks the man, “Is that your lunch?” And then I hear (from the man): “Yeah. I’m on a diet. My goal weight is four pounds.” I turn around. He notices me, noticing him, and asks, “What do you think? Is that a good goal?”

I glance back at my computer screen before replying, “I’m writing a book on eating disorders, so I’m going to go with ‘no.’”

He laughs, but then continues: “My whole life, I’ve wanted to be anorexic—but I’m always hungry. I wish I were anorexic.”

“No you don’t,” I quip.

“Yes, I do—my sister was anorexic. I was so jealous.” I stare. “I’m just kidding,” he says. “I joke a lot.” I freeze, caught between a general tendency toward humor appreciation and not wanting to condone a joke about an issue I take so seriously, managing only a half-smile in return. He tells his companion, “I’m going to go back there (he points), before she hits me in the head.”

A friend overhears the exchange and states the unspoken truth: “Theoretically, you could never stop writing, because people are going to give you material wherever you go.” It’s true—even as I sit here writing, there’s something more to tell. At some point, I hope to put this in print, but long after I tire of writing on this topic, there will always be another story, another joke, another conversation. . . .

Generations

The Oprah show recently focused on the body dysmorphia now common, even amongst little girls. The show featured two pre-schoolers and a teenage model, all of whom hated their appearance or took drastic measures to conform to a beauty ideal.

The first guest was a three-year-old little girl, a regular Victoria Secret catalogue reader, who throws tantrums when not allowed to wear make-up like her mom. According to her mother, the girl screams, “I hate you Mommy!” when she doesn’t feel pretty enough. Explanations for this? Her mother seems to spend quite a bit of time prepping herself when going out, applying make-up and performing multiple mirror-checks. Mother says, “I don’t recall ever being told ‘You’re beautiful,’ so I’m constantly telling her how beautiful she is.” So, why doesn’t her daughter listen to her? It seems the adage, “Do as I say, not as I do” is most illustrative here.

The second guest, a skinny four-year-old is intensely afraid she’ll become fat. How might such fear arise? Her mother insists that her daughter’s pre-school classmates called her “fat,” stating, “I honestly believe that she’s learning it from just being around other girls.” You do? Because what about, as the show later reveals, your history of anorexia? Turns out mom struggled with anorexia for years, and even now limits all food intake to servings “smaller than a cup” and exercises daily, sometimes twice a day. It’s not surprising that her daughter is restricting her portions and leading her own makeshift aerobics class in the home, is it?

The third guest is a 19-year-old model and soccer-team captain. She reports that at age seven, she couldn’t go to school because her face was “too ugly,” and today, she tends to shatter mirrors and destroy pictures of herself. She, at times, turns her destructive impulses on herself, reporting suicidal ideation and a history of cutting. After hearing from this young woman, we meet her mother, whom her daughter often overhears as saying, “I’m so ugly!” Mom and daughter, from time to time, compete in the “Who’s fatter?” game.

In all three cases, we see daughters, despite well-intentioned mothers, who internalize their self-reproach. A daughter whose mother struggles with body acceptance will likely do the same, as her mother tacitly, but forcefully, conveys that thinner is better and condemns any shape that does not conform. It is my contention that for mothers, no matter how much love you give your daughter, or how much regard you show her, if you dislike your body, your daughter will do the same.

You Should Consider This

Karen Horney, a pioneering psychoanalyst, who followed in the footsteps of Freud, spoke of the “Tyranny of the Shoulds,” the self-haunting that occurs when we compare how we are to how we think we should be. Focusing on this discrepancy results in, as you’d expect, significant distress, and the solution, according to psychologists, analytical and cognitive alike, is to avoid the use of should—not just to remove the word from our vocabulary, but to be more compassionate with ourselves and lighten up with (often) unrealistic expectations.

I should lose 10 pounds.
I should exercise for two hours today.
I shouldn’t eat that cookie.
I should stick to my diet without any exceptions.
I should be thinner than I am.

Also, beware of the relatives of should: have to, need to, want to (with sufficient angst). Why are these all so damaging? Because truth is, it’s hard to lose weight, to exercise regularly (and excessively), to restrict, to limit, and to shrink your body beyond its natural weight. And when we get caught up in the “should” (instead of the “could” or the “would like to”), we set ourselves up for disappointment and self-reproach, both of which play an integral role in sabotaging our personal goals and further unsteadying an already shaky self-regard.

Hmm. . .

I was at some friends’ house for dinner one night. On the kitchen counter, they had a baby picture of their niece, now five years old. Another guest commented on how chubby the five-year-old had been as a baby—“fat baby,” “not a cute baby,” and how “it’s a good thing she turned out cute.” Half an hour later, the same guest is talking about children’s clothing and specifically about her young daughter’s preferences. “Would you believe that she’s only six, and she already won’t wear one of her coats, because it makes her look fat? I don’t know where she gets that from.”

A Girl Can Dream

(written to the editor of Star magazine)

Dear Editor:

I am writing in regard to your recent (August 28th) feature about Nicole Ritchie, entitled, "Bare Bones!" As Pearson, Clark, and Levine note, Ms. Ritchie is grossly underweight.

My concern is that anorexia, a serious (and often lethal) physical and psychological condition is not represented properly in the article. The writers quote Christine Bybee, a "nutritionist and fitness expert" regarding Nicole's condition: "'A true anorexic looks like a walking skeleton. . . . At that point, a person needs to be hospitalized. Nicole isn't there yet."

Unfortunately, Bybee's statement is wholly untrue. First, it is impossible to judge whether someone is anorexic simply based on her appearance. A comprehensive clinical interview is necessary, and, even then, a diagnosis may be difficult if the patient is not forthcoming. Second, not all anorexics have the look of a "walking skeleton," as the diagnosis requires (amongst other criteria) that a patient weigh less than 85% than expected--how this translates into "looks" varies by individual. Finally, hospitalization can and does occur at various points along the continuum of eating-disordered symptoms and is not simply a stop-gap, life-saving measure once a patient appears to be "a walking skeleton."

I write with concern that your readers may, based on the above misinformation, understand anorexia to be less serious (or more black-and-white) than it is. Nicole Ritchie is, even by her own account, "too thin," but to label her as anorexic (or not) is questionable journalism, given the complexity of the diagnosis. Moreover, information about an eating disorder (a mental health disorder) diagnosis and treatment should come from a mental health professional, not a nutritionist or fitness expert.

I urge you to promote responsible journalism, particularly with regard to a disease as grave as anorexia, as many young women are turning to celebrity magazines for information about this condition.

Sincerely,
Drstaceyny
Licensed Psychologist (specializing in eating- and body-image concerns)

I'm Worried About Your Health

In The Diet Myth, Paul Campos discusses the “disease” of obesity as a socio-cultural construction designed to underhandedly fuel bigotry against fat, as well as to potentiate racist and ethnocentric thought. How many times have we heard, “You see, it’s not that you don’t look good—it’s just your health that I’m concerned about”? In his journalistic account of the weight-loss research enterprise (and industry), Campos debunks this myth by presenting facts exposing that (exact quote):

1) The health risks associated with increasing weight are generally small, in comparison to those associated with, for example, being a man, or poor, or African American.
2) These risks tend to disappear altogether when factors other than weight are taken into account. For instance, fat active people have half the mortality rate of thin sedentary people and the same mortality rate as thin active people.
3) There is no good evidence that significant long-term weight loss is beneficial to health, and a great deal of evidence that short-term weight loss followed by weight regain (the pattern followed by almost all dieters) is medically harmful. Indeed, frequent dieting is perhaps the single best predictor of future weight gain.
4) Despite a century-long search for a “cure” for “overweight,” we still have no idea how to make fat people thin.

It’s interesting how often the “health” card is invoked, even amongst medical and psychological professionals. Truth is, there’s really no way to evaluate people’s health based on how they look. And yet, we do it all the time. So, now what? Without the “health” argument to back us up, how should we disguise our disgust with fat?

Housekeeping

I'm 82 posts into my 100-post, daily (weekday) goal (yes, this one counts!), and I thought I'd take a moment to reflect, as well as to ask for feedback.

Starting out, I made two conscious decisions (well, at least two, let’s hope) in designing this blog. Number one, I decided I wouldn’t sell out to Google. Not because I wouldn’t like the money that would come with your every click—I would. But, you know exactly what would happen if I signed up for Ad Sense—in no time, you’d see ads on my site for diet pills, weight-loss gimmicks, and a host of other products designed to make you feel bad about yourself. Not here.

Second, I’ve purposely withheld information about my current weight or shape, as well as pictures of myself. My thinking here is that I don’t want to align myself with fat or thin, or with any other point on the body size continuum. Part of the motivation for this book is to illustrate how widespread eating problems are, and how they affect (and unite) us, big and small. This struggle belongs to all of us.

As I'm turning the final corner for my daily-post goal (after 100, I'll still post, though likely not with the same consistency), I have a couple of thoughts that I might like to explore the next several weeks. To start, I am forever grateful for your thoughtful comments. They've helped me to solidify many of my ideas, as well as to engender new ones. That said, I encourage those readers who read regularly but haven't commented to speak up--I'd love to hear from you.

Given the interesting questions that regularly come up in the comments section, I'm thinking about devoting one day a week to a Q & A process. If you'd like to ask a question, please email me directly, and I'll compile and present them once a week. Questions could be personal, general, about you, about me, about anything. . . . You know the (disclaimer) drill--what I write shouldn't subsitute for face-to-face contact with a trained professional.

I'm also considering the idea of allowing a couple of regular readers to guest-post about their experiences related to food/weight. Let me know, again, by email, if you'd like to participate. Related to this, if you like to tell your "story," please let me know if I might contact you re: "appearing" in my manuscript (with all identifying information removed, of course).

Within the month, I'll be submitting some of my work to agents (yes, now I've committed myself to a deadline!), so please let me know if you have any feedback (what you liked/haven't liked), as I pull together various posts.

Again, thank you so much for all your insights. I hope that some of the ideas presented here have been as helpful to you as you've been to me. . . .

Mixed Messages

In a Details magazine feature, entitled, “Why Fat Is Back in Hollywood,” writer Holly Millea discusses how the super-thin look is slowly being countered by a curvy, more feminine look, reminiscent of old Hollywood and pin-up stars. Millea offers Catherine Zeta-Jones, Scarlett Johansson, and Drew Barrymore as evidence. Even Rachel Weisz, Lost star Evangeline Lilly, and Mandy Moore are thrown in the mix.

But, let’s take a step back. These women are so far from “fat,” that I’m afraid they’ve landed in the wrong article. Rachel Weisz might only be described as “curvy” when with child, Evalengline Lilly is as athletic and toned as they come, and Mandy Moore is. . . Mandy Moore. Are we that skewed that these women are the only ones we can identify as “fat”? (The answer is “yes,” I’m afraid.)

Millea makes some interesting points and challenges us to confront the status-quo assumption of thinner-is-better. She asks, “Seriously, would you prefer to get a Grey’s Anatomy lesson from an hourglassed Katherine Heigl or a reedy Ellen Pompeo?” Point taken, but even here, we can’t look at their bodies without objectifying them, without bringing it back to sex. There’s no beating around the bush here:

You see that look in the faces of formerly fleshy sexpots who have morphed into pinched, prematurely aged superwaifs. What do they do for fun? Food and sex are appetites inextricably linked in the human psyche. One could speculate that for those obsessed with not eating, even the boyfriend’s salami goes the way of the bread basket.

The message? Don’t starve yourself down, not because it isn’t healthy or because it irreparably damages your psyche and your will to live or even because it sets up an (often deadly) unrealistic standard for your fans, but because it’s just (shoulders raised) not so sexy. Hit ‘em where it hurts, and, maybe, we’ll tackle some ground.

Hillea realizes the difficulty of positing a world taken over by the “lush,” “curvy,” forms of Johanssen and Zeta-Jones (now that we’re on the topic, are they really larger than a Size 6?):

Of course, it’s easy for anyone who isn’t an aspiring actress to beat the drum for weight gain. Our careers don’t depend on being a jean size smaller than the next girl. As one male studio executive who asked not to be named says, “Do we really want stars to look like the rest of us? If actresses represented the way the public really looks, the mother from Gilbert Grape would be a sex symbol.”

It seems that that’s the ultimate fear—if we accept Drew Barrymore as body-beautiful, then we’re just a couple of steps away from accepting obesity (in others and ourselves). Not to mention the fact that 500-pound Bonnie Grape is no more representative of her public constituents than Kate Bosworth, Nicole Richie, or the shrinking Keira Knightley.

I’m always interested in journalism that confronts body stereotypes, and the premise here is pure. Even the article’s subtitle, “In an industry rife with painfully thin stick figures, women with some meat on their bones are—lucky for us—rising to the top” offers a respectable purpose and heralds writing I’d like to read. But, sprinkled with not-so-fat celebrity examples, black-and-white thinking (see quote above), and an accompanying graphic (see below) that all but refutes anything said, the take-home message is confusing and elusive at best.

Transgressions

The National Eating Disorder Association’s (NEDA’s) media watchdog program, which began in 1997, targets advertising that portrays unhealthy messages about body shape and size, with the understanding that such messages may contribute to the incidence of eating disorders. According to NEDA, over 50% of the protested ad campaigns have been discontinued as the result of such advocacy.

In 2002, when I first learned of, and became involved in, the campaign, I met with female students at a local university in order to get their feedback on the ad above. The promotion, for Nutri-Grain breakfast bars, features a slim, attractive woman with two cinnamon buns affixed to her rear end. You may remember similar television ads, including one, this time whose subject was male, who wore a frosted doughnut wrapped around his middle.

Aside from the obvious untruth (cinnamon buns don’t land directly on your buns, nor doughnuts on your waist, and it’s exactly this type of thinking that encourages people to seek out widely proliferated, but highly ineffective, techniques for “spot reduction”), what struck me most about this ad, and when led to the most interesting discussion at the college, was the copy, which does away with subtlety and diplomacy and instead bodes consumers to “Respect yourself in the morning.”

Lest this be unclear, eating a Nutri-Grain breakfast bar allows you to maintain your self-respect. Eating a cinnamon bun (or two), quite obviously akin to engaging in an unplanned, unladylike, orgiastic feast the night before, does not.

It’s interesting, this juxtaposition of food and morality (sprinkled with a healthy dose of sex) that seems to repeatedly be played out in our thoughts and conversations. “I was good” or “I was bad” don’t have anything to do with characterological or behavioral transgressions, but instead with what we ate. It’s not surprising that Madison Avenue caught on, recognizing that how we rate ourselves morally, and how we feel about ourselves in general, is largely tied to what we eat. Breakfast bar or cinnamon bun? Madonna or whore? You make the call. . . .

So You Think You're Thin Enough?

Are you following So You Think You Can Dance? They’re down to the final two female dancers, and I can’t help but notice that Donyelle has about 25 pounds on Heidi. I know it’s not just me. Either the contestants themselves or some higher ups on the show notice the discrepancy, too—it’s reflected in their costume choices. While Donyelle is typically covered, often in long pants and sleeves, Heidi’s look is as skin-baring as possible. She gets to wear the sequined skirts, midriff-baring tops, and form-fitting dresses that we’ve come to associate with dancing, skating, pageantry, femininity, and. . . being thin.

When the two performed a number together, wearing two-piece, pin-striped suits, Heidi’s top cut off about four inches above Donyelle’s. It’s interesting how a weight-discrepancy wouldn’t be so obvious amongst male contestants, where costumes aren’t typically as flashy and revealing as they are for the fairer sex.

Let’s be truthful, when it comes to bodies, Heidi’s closer to the American ideal (in more ways than one). Perhaps aided by her boxy shoulders and jutting hips, her lines are angular, and her dancing seems crisp. Notwithstanding technical ability, I wonder how weight and shape will influence our national vote and if it’s possible to evaluate dance without attention to size.

(The two-hour season finale airs tomorrow night.)

Stomach Bugs

This weekend, The New York Times Magazine featured an article entitled, “Fat Factors,” suggesting that a previously unconsidered factor may be to be blame for your weight—microogranisms.

The article’s author, Robin Marantz Henig, describes recent research indicating yet another biological theory of weight—we already have about 50 “guilty” obesity genes, some of which regulate appetite, satiety cues, and activity level. But now, scientists are exploring the possibility that intestinal microbes (e.g., bacteria, fungi, etc.) may play a role in how fat you come to be. And, lest you have any lingering doubts about an uncertain future, Jeffrey Gordon, the director of the Center for Genome Sciences at Washington University, informs us: “‘Microbes colonize our body surfaces from the moment of our birth. . . . They are with us throughout our lives, and at the moment of our death they consume us.’”

According to Henig’s article, microbes (microflora) accomplish a multitude of gastro-intestinal tasks, including the production of vitamins and enzymes, as well as the facilitation of digestion. Henig writes that they “help extract calories from the food we eat and help store those calories in fat cells for later use—which gives them, in effect a role in determining whether our diets will make us fat or thin.” Thus, my 450-calorie meal may be different than yours. It’s possible that I will extract and store 400 of these calories, you only 300, based on varying levels of intestinal microbes, thus complicating the classic calories-in-versus-out method of weight-loss or -maintenance. And, the formulaic 3,500-calorie reduction requisite for a one-pound weight-loss? Again, not so rigid when microbes are involved.

The Times article details animal studies, suggesting that bacterial microflora and/or exposure to certain viruses (“infectobesity”) lead to increased incidence of obesity. In other words, catching a virus can make you fat. Correlational studies in humans seem to support this notion—those with certain viral antibodies are more likely to be obese. Viruses may lead to increases in fat-cell counts and size or may toy with the brain’s satiety center.

While data are still preliminary, researchers are already toying with antibody tests (documenting exposure to one of the implicated viruses), and as you might imagine, antiviral-drug administration looms in the horizon. What I find most interesting about this report are its psychological and sociocultural correlates. Here, we have yet another biological theory of weight (the existence of obesity genes, preceding it) and yet, we still hold strong to the belief that obesity is a psychological condition, an individual failure of will-power, conviction, and self-regard, when in fact, there are plenty of “overweight” people who eat no more than their thinner counterparts. More and more, research is debunking that myth. Henig details an interesting example discussed by Rudolph Leibel, a Columbia University obesity researcher, “. . . if you take two nonobese people of the same weight, they will require different amounts of food depending on whether or not they were once obese. . . formerly fat people need to eat less than never-fat people to maintain the exact same weight.” The possibility of a microbial factor in the incidence of obesity lends weight to the notion that losing weight may be more of an uphill battle than previously thought.

And there seems to be good reason for this. Transport overweight people back in time, and they’re likely to fare better than those who are thin. As Henig notes, the “thrifty-genotype” hypothesis of weight suggests that historically, there was an evolutionary advantage to packing on the pounds. Now, technologically advanced beyond famine and draught, there’s no such need for biological stores, but let’s not underestimate the power of context—put obese people in another time and another place, and they’re royalty, exalted for their natural inclination toward getting fat and “keeping it on.” They survive, while the skinny perish, somehow unable (or not having the discipline) to eat enough.

Family Conflict

In an episode of Showtime’s series Weeds, Celia Hodes (Elizabeth Perkins) regularly weighs her daughter, Isabelle (played by 12-year-old Allie Grant), and as the scale tips, accuses Isabelle of sneaking food. The solution? Celia sneakily swaps part of Isabelle’s candy bar for a chocolate laxative, landing Isabelle in the elementary school bathroom and as the flatulent target of her peers. Isabelle’s father yells at Celia, “They called her, ‘Shit Girl!’”

“Well, better than ‘Fat Girl,” Celia replies. She continues, “It is cold and cruel out there for fat girls.”

Incidentally, the sour apple doesn’t far fall from the tree. Privy to her mother’s guile, Isabelle plants Immodium in Celia’s Trimspa bottle, rendering the bathroom-happy Celia as bloated, constipated, and enraged. As she makes camp on the toilet, reading, doing the crossword, filing her nails, chugging water, and even nodding off, Isabelle’s in bed, polishing off a chocolate bar. Her response to her mother’s frustrated screams: a smug, complacent, “Bitch.” Was Isabelle hungry? Maybe. Craving chocolate? Perhaps. But, it’s clear that rebellion trumps all else, that the chocolate bar is a prop in an ongoing family struggle that ultimately has no victor.

Honesty

(from postsecret)

Cravings

I don’t think there’s anything wrong with wanting to be thin, or thinner than you are. In fact, I’d say there might be something wrong if you were not affected by (or hadn’t internalized) the hordes of media messages we receive on a daily basis, suggesting that this be your ultimate goal. But, it’s interesting to me how body dissatisfaction so easily turns emotional and destructive.

Outside of your weight or shape, I’m sure there are things about your appearance that you don’t find ideal. Maybe your hair’s frizzy, or your complexion’s spotty. Maybe your feet are funny. As a personal example, I point to my fingernails. No matter what I do, they don’t grow. As soon as they’re about an eighth of an inch beyond my fingers, they snag/peel/break, and they’re off. Sure, there are some things I can do (nail hardeners, for example), but the bottom line is, oh, well, I’m never going to have long nails. And I’m ok with that.

Why can’t we be this way about our bodies? Desiring to be thinner, but resigned to how we are. We might be disappointed by a “problem” feature, and we may even try to fix it, but nothing, in my mind, packs the same emotional punch as not weighing what we should. Nothing has such a grip, such a soul-clamp, on who we are as the gap between our bodies and how we want them to be.

Pageant Culture

In the recent film, Little Miss Sunshine, 7-year-old, pint-sized, beauty-pageant contestant Olive Hoover is faced with a harrowing dilemma: with her family at a roadside diner, Olive orders waffles a la mode, only to draw criticism from her motivational-speaker father, to the tune of, “eating fat makes you fat.” Olive ponders the diminutive dish of chocolate ice cream before her, as her father persuades her to abstain (citing qualitative statistics—pageant contestants don’t eat ice cream!), and she dejectedly, but resolutely, resists.

Once at the Little Miss Sunshine pageant, Olive prepares for her swimsuit and talent competitions, decidedly unlike the other pre-pubescent participants. Her hair isn’t hot-iron curled, her body isn’t blasted with fake tanner, her make-up is subtle, and her mother is comparatively unobtrusive. But, prior to taking the stage, Olive, in one of the saddest scenes of the film, pauses in front of the mirror, and seems to catch her reflection for the first time. She self-consciously evaluates her childlike frame, and you can almost read her mind. It’s a moment that signifies hope shattered, innocence lost, all in pregnant gaze. She’s a bit pudgier than the other girls, and she’s probably grateful she didn’t indulge. Olive looks at her reflection with a disappointment that can only reflect the internalization of adult-like messages, and in a flash, she seamlessly morphs into a pageant contestant.

Role Model

Mara Reinstein is an entertainment writer for US Weekly, who last year, was diagnosed with enteritis, a “bacterial disease” that resulted in significant gastro-intestinal stress. Due to the disease, the normally thin Reinstein lost weight and was surprised by the reactions she received. In a recent issue of Glamour magazine, Reinstein asks, “‘Why was the outside world so thrilled with my ravaged body?’” It seems that friends and family celebrated her 11-pound weight loss, which resulted in her being significantly underweight, and which, incidentally, also resulted in her inability to hail a cab, keep color in face and ample fluid in her system, or sometimes, even, simply, to sit up.

What I find inspiring about Reinstein’s Glamour piece is her surprise about people’s reactions, as well as her commitment to re-gain her weight (and health). Reinstein writes: “‘It took a life-threatening illness to make me realize how much my peers value being ultra-thin. Now I understand why some celebrities succumb to the allure of jutting ribs in string bikinis: Their bizarre habits are rewarded with compliments from their handlers, friends, and fans.’”

Reinstein reports that she’s re-gained her weight, but has “‘never felt better about her body.’” While it may be hard for some women to identify with someone whose baseline is a Size 6, I’m happy that Reinstein wrote this piece and even happier that she can provide a different (read: healthier) perspective for the entertainment/celebrity industry. As a staff writer, maybe she can convince US Weekly editors to reduce the magazine’s features on ultra-thin women (do we really need another piece on Keira Knightley?), or maybe she’ll just hesitate to write such pieces herself. Baby steps. . .

OO

In Overcoming Overeating, Jane Hirschmann and Carol Munter presented one of the first guides for intuitive eating, namely eating when you’re hungry and stopping when you’re full. As they contend, a compulsive eater is not addicted to food, but to the diet-binge cycle. Their theory purports that overeating results from overly rigid (diet) standards, and that it is your (healthy) way of asserting yourself. Hirschmann and Munter write:

You the hopeless case feel out of control and despondent because you’ve bought the line that you’re a failure at the idealized task of body shaping. But you the rebel are a success. You break the rules and assert your right to eat what you want and look as you do. The compulsive eater is, in an interesting way, a rebel in constant protest against what has, by now, become her own imposition of cultural standards and judgments.

Their approach allows you to eat whatever you’re craving in a given moment and focuses on equalizing different kinds of food, so that you can arrive at a place where a carrot has the same value as a slice of carrot cake. Whenever you’re hungry, you’re encouraged to ask yourself what you’re craving: Something sweet? Salty? Crunchy? Mushy? Hot? Cold? And, you’re encouraged to eat exactly what you’re craving. Time and time again, Hirschmann and Munter (in their clinical work) have found that people may make some unhealthy choices early on, but eventually their bodies regulate and they begin to crave, at different times, foods across the spectrum.

Other aspects of Hirschmann and Munter’s approach include:
1) Carrying around a food bag, stocked with different types of food, in order to prevent those moments of excessive hunger that lead to overeating.
2) Cleaning out your closet to reflect your current weight—either giving away or hiding the clothing that no longer fits, since seeing it on a daily basis is a reminder that you’ve “failed.”
3) Stocking your home with an array of foods, including what they call “formerly forbidden foods.” The theory is that by exposing yourself to foods that you used to deny yourself, you’ll, over time, reduce their “glitter,” and, consequently, their grip on you. As for amounts? Hirschmann and Munter encourage you to have, on hand, three times the amount of food that you’re capable of eating in a binge. Ideally, it’s all in a single container (think stuffing three bags of Oreos into a large plastic container), so that you’re not able to get caught up in amounts (“I’ve now eaten an entire row”), but instead can focus on what your body wants. We tend to overeat when we know there’s a limited amount (possibly a relic of dieting, in which we’re stocking up before a self-imposed draught).
4) Thinking beyond meals—eating when you’re hungry and not around a preordained schedule. In practice, this results, typically, in more than three “eating experiences” per day.
5) Engaging in “mirror work,” in which you practice looking at your body, without judgment.
6) Working at distinguishing between “stomach hunger” (when you’re physiologically hungry) and “mouth hunger” (when you’re craving food out of boredom, anxiety, anger, loneliness, or any other motivation that doesn’t involve physiological hunger) and, over time, arriving at a place where you’re eating more frequently out of stomach hunger and able to identify mouth hunger and why you might be experiencing it.
7) Tossing the scale.

Various aspects of this approach (or the approach in its entirety) may seem ridiculously radical, particularly in a culture that preaches regular meals, precision, restriction, monitoring, and self-loathing. Certainly, it won’t work for everyone. But, I’ve found that it can be quite helpful for women who have historically cycled through the diet-binge chain, who would like to disempower the hold that food has on their lives, and who are interested in promoting a body image governed by self-acceptance.

Just Say No

My office refrigerator is broken. Notwithstanding the fact that New York City (the land of delivery) is one of the only places where a major kitchen appliance could be broken for months without major repercussions, I realized this week that, in fact, there is some eating-related fall-out when the refrigerator goes kaput.

Take my recent lunch experience. I ordered (delivery, of course) a slice of pizza and a side of sautéed spinach. The order arrives, and it’s enough spinach to feed a family, certainly much more than I’d like for lunch, and unfortunately, storing leftovers is not an option. As I’m spooning the spinach from the take-out container onto my plate, I pass the amount that I want and add some extra, thinking to myself, “I better have a little more, since I’m going to have to throw it out.” I catch myself and pause. What????

There are plenty of reasons for me to have more spinach, but, at the time, none of them has anything to do with me and what I want. I should eat more spinach so that there’s less to throw out? What’s that going to do? I eye the trash container on the kitchen floor and, quite mercifully, notice a number of differences between it and me.

It’s funny how the notions of “clean your plate,” “finish your meal,” “starving children in [third-world country],” subtly, but tenaciously, cling to our collective unconscious. How even someone who’s built her personal and professional lives around intuitive eating so easily falls into a trap like this.

I’m not happy that I had to throw the spinach out (in an ideal world, I would have given it to someone else), but I am happy that I tossed my amateur trash-can impersonation and recognized that just because someone gives me more than what I want, doesn’t mean I have to take it.

Neuticle Rant

Think cosmetic surgery is just for humans? Think again. More and more, veterinarians are approached by pet owners, looking to put their pooches under the knife. While it seems that most canine surgeries are performed for actual medical reasons, some, surprisingly, are not. Take the case of neuticles: testicular implants for male dogs, designed by Dr. Gregg Miller, a vet from Missouri.

In an issue of Animal Fair magazine, Dr. Miller explains that neuticles “are for ‘neuter-resistant pet owners’ who want their dogs to retain their masculinity and self-esteem.” Um. . . who, exactly, are we talking about here? The dogs? Can anyone point me in the direction of a female pet owner who insisted on installing a pair of neuticles in her pet?

Dr. Miller reports that the procedure has allowed for a reduction in the pet population (because neuter-reluctant pet owners are now willing to succumb to surgery). That’s fantastic, but is an artificially-stuffed sac really what it takes?

(And because my writing is about women and body image), is there any parallel between dogs undergoing surgery to please their (male) owners and women undergoing surgery to please their (or attract some) men? Neuticles are a hit because male pet owners use their dogs as narcissistic extensions of themselves. Sure, they may not be feeling as manly as the next guy, but their neuticle-sporting pets may help them negotiate the difference. Is it possible that a husband who encourages his wife to get breast implants, or a man who supports his already-thin partner’s decision to get liposuction, is doing just the same? Because a man with a (unnaturally) thin, large-breasted woman on his arm can advertise his masculinity (especially to other men) and compensate for a lack of self-esteem in much the same way as an extra pair of testicles for all the world to see.

Terri Schiavo

If I asked you to free-associate to the name, Terri Schiavo, you’d probably come up with something like the following: right-to-die, brain damage, family conflict, court order.

But, especially if you’re attuned to these matters, you may recall the eating-disorder speculation surrounding Schiavo's deterioration. The family battle central to Schiavo’s right-to-die case took center stage, shadowing what very possibly caused Schiavo to slip into a persistent vegetative state in the first place, an eating disorder. Reports indicate that the 5’3” Shiavo, who weighed 220 pounds at her heaviest, but who had lost 65 pounds, continued to struggle with her weight for years.

In 1990, Schiavo collapsed and her heart stopped beating temporarily. A malpractice suit against Schiavo’s doctor, brought on by her and her husband’s lawyer, Michael Fox, suggests that Schiavo collapsed as a result of an eating-disorder induced potassium imbalance. A 2003 article in The St. Petersburg Times written by Fox states: “One night, Terri purged, which caused her potassium level to drop low enough to cause a heart attack. Before fire rescue arrived and took her to the hospital, Terri's brain had been deprived of oxygen for long enough to produce catastrophic brain damage.”

In a 2005 Associated Press article appearing in USA Today, a reporter writes: “Medical records from the hospital where Schiavo was treated after her collapse note that ‘she apparently has been trying to keep her weight down with dieting by herself, drinking liquids most of the time during the day and drinking about 10-15 glasses of iced tea.’” The article also suggests that Schiavo had stopped menstruating, and that when Schiavo sought medical attention, her doctor was negligent in not inquiring about eating-disordered activity.

Of course, whether or not Schiavo suffered from an eating disorder is still debated. As other aspects of the case revealed, it seems to boil down to one person’s word against another’s. Unfortunately, even an autopsy report doesn’t provide definitive data on an eating disorder diagnosis. But, given the serious speculation, I think some interesting points arise. The USA Today article, published while Schiavo was still alive, notes: “It is a cruel twist lost on no one close to the case: A woman who is said to have struggled with an eating disorder is now in the middle of a court battle over whether her feeding tube should be removed so that she can starve to death.”

Moreover, if Schiavo did, in fact, suffer from an eating disorder, typified by concerns with body-image, self-presentation, and others’ judgment, it seems pretty clear to me that she would not have wanted the media attention she garnered during her final moments and even clearer that she would not have wanted to persist in a state that was largely unreflective of whom she hoped to be.

How Far Back Do You Have To Go?

I think it’s helpful to ask the question: How far back do you have to go to arrive at a time when you weren’t aware of your body? 12 years old? 10? 4? One woman I asked this question to once said, "I can’t even remember a time."

If you can recall a time, can you remember how it felt? To be naked, or in a swimsuit (or even clothed, for that matter), and to NOT be aware of your body. . . to have built a sandcastle on the beach and focused on the sand and the tide and not your body. . . to have run through the sprinklers and focused on zipping through the wet grass and your friends and the heat and the drench, but not your body. . . to have showered or bathed and focused on the scent of the soap or the sensation of the water striking your body, but not your body.

And, have there been any recent moments (even fleeting) when you recaptured this unawareness and reveled in the experience, without a thought of the size of your stomach or the width your hips or the dimples on your thighs? What variables contribute to your ability to ignore your body (or its appearance) in these moments? I’d guess it has something to do with being fully in the moment, absorbed by a connection, or a feeling, and that it’s impossible to be completely focused on this and your body at the exact same time.

Slink Away

Ever heard of a brand of jeans called “Slink”? A friend alerted me to them, after a frustrating clothes-shopping experience. It seems that Slink jeans run about three sizes too small. Said friend is pretty tiny and typically wears a Size 4/6. During this particular dressing-room encounter, she tried on a Size 10 which was, surprisingly, too tight.

What awful marketing, I thought, at first—clearly the Slink execs haven’t consulted with the marketing folk over at Banana Republic (who know that women love to buy clothes a size smaller than they usually are). But, perhaps this is strategic marketing at its best—to size out even normal-size (read: thinner than average) women ups the ante, placing the brand in a prized, elusive category only meant for a select few. I bet Nicole Richie can fit into Slink jeans. Keira Knightley, too. If only we can diet ourselves down, starve ourselves, purge ourselves of anything unnecessary, then, perhaps we, too, can fit into a pair of Slinks.

Cartoon of the Day

This appears in the current issue of The New Yorker, from a cartoonist named Weyant.

Thoughts? Captions?

What Constitutes a Binge. . . Disorder? (Part II)

In its proposed criteria set for Binge Eating Disorder (i.e., the disorder, not just the binge), the APA's Diagnostic and Statistical Manual (IV-TR), includes, in addition to the features of a binge (described earlier), the following points:

A. The binge-eating episodes are associated with three (or more) of the following:
1) eating much more rapidly than normal
2) eating until feeling uncomfortably full
3) eating large amounts of food when not feeling physically hungry
4) eating alone because of being embarrassed by how much one is eating
5) feeling disgusted with oneself, depressed, or very guilty after overeating

B. Marked distress regarding binge eating is present.

C. The binge eating occurs, on average, at least 2 days a week for 6 months.

D. The binge eating is not associated with the regular use of inappropriate compensatory behaviors (e.g., purging, fasting, excessive exercise) and does not occur exclusively during the course of Anorexia Nervosa or Bulimia Nervosa.

It's interesting to me how important the "marked distress" feature is. In fact, if you're not feeling this level of distress, but you're still bingeing (even regularly), you wouldn't meet criteria for BED. And, in my interpretation, this includes distress before/during/after a binge, as well as distress about the overall pattern.

In the July issue of O magazine, writer Anne Lamott describes her experience with a a "classic" binge. Having been largely binge-free for 15 years, Lamott recently succumbed first to the allure of a Safeway apple fritter, triggering a no holds barred journey to binge-land. In my opinion, it's not really about her food choices or how much she consumes. I think it's the emotional report that she nails: "I was so lost, and I couldn't follow the bread crumbs back to the path of mental health, because I'd eaten them all. So I ended up eating junk, off and on, until bedtime. . . . It is hard to remember that you are a cherished spiritual being when you're burping up apple fritters and Cheetos."

Interestingly, Lamott describes a critical feature of a binge (beyond quantity and control) that seems, in my mind, just as relevant to the diagnosis: the aftermath. This is an aftermath filled with guilt, shame, self-hatred and sentencing, promises, punishment, and enough of an emotional charge to knock you (as you might want to be) flat-out unconscious. It's an aftermath so uncomfortable that it can, often, only be soothed by more eating, an irony that fuels the cycle and continues the pain.

What Constitutes a Binge? (Part I)

According to the American Psychiatric Association’s Diagnostic and Statistical Manual (IV-TR), a binge is characterized by the following:
1) Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than most people would eat in a similar period of time under similar circumstances.
2) A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating).

Binges may occur in isolation (and without any correlated behaviors) or may be a feature of Bulimia Nervosa, Eating Disorder Not Otherwise Specified, or Binge Eating Disorder (not yet a clinical disorder, but likely will become one.) They may occur at lightning speed or be longer-lasting, may include eating one food, or many. And, clearly, even the clinical criteria are quite ambiguous: What exactly is an amount of food “larger than most people would eat”? Who are these “most people?” Are they of our same gender, size, culture, and eating-disorder status? What are “similar circumstances”? Moreover, can you always detect when you’re feeling a “lack of control” and is there even any way to quantify control? You’d think that as a science and a practice, we’d be able to do better than this. . . .

With such ambiguity (and diversity) in a clinical presentation, how do you really know if it’s a binge? Justice Stewart’s definition of pornography comes to mind (“You know it when you see it”), yet introspective awareness may be somewhat limited during a binge (though possibly enhanced after one). I think the control factor is a big one—if you feel like the eating behavior is controlling you (rather than you, it), then that could be a binge, but of course, the quantity consumed cannot be ignored (uncontrollably stuffing back a bag of airline peanuts, for example, can’t really be labeled a binge). Just because you’ve eaten more than you wanted, eaten past the point of fullness, or eaten when you weren’t even hungry doesn’t make it a binge.

I return to my old-standby, the continuum, when confronted with ambiguous topics like this. It seems it’s clear when it’s not a binge, and even pretty clear when it is a binge, but for all the shades of grey in between (particularly the darker greys, toward the binge-end of the continuum), I’d say this is a highly idiographic enterprise—I’d want to know from you as an individual—did it feel like you wanted/needed to binge? Did it feel like a binge during the binge? How about after? Because, especially when the science is so vague, the person is expert and the subjective experience quite diagnostic.

What makes it a binge for you?

BMI Tables

The Body Mass Index (BMI) is a simple measure, based on height and weight, commonly used to determine if someone is overweight. When policy makers and public health officials talk about the obesity crisis in America, they’re usually referring to BMI data, which, when considering the host of variables that should be taken into account when determining the health consequences of weight (i.e., muscle weight), emerge as overly simplistic. In The Diet Myth, writer Paul Campos offers a few examples of "fat" celebrities, according to BMI definitions (over 25 = overweight, over 30 = obese). Coming in as overweight are: Brad Pitt, Michael Jordan, and Mel Gibson. Obese celebrities include: Russell Crowe, George Clooney, and Sammy Sosa.

Campos goes on to say that current BMI definitions are not intended “to apply to people in ‘good shape.’” However, since one of the primary goals of public health initiatives (and the weight-loss industry) is exactly that, for people to be in “good shape,” then why wouldn’t current BMI criteria apply to them?

The Rape Scene

I recently learned that child actress, Dakota Fanning, has signed on to a role in the movie Hounddog. According to reports, the film takes place in the south and has Fanning’s character raped in one scene and appearing nude in others.

Any cinematographic rape scene is disturbing. But, a 12-year-old girl? Reports indicate that Fanning’s mother and agent are supportive of her casting, believing that this role could have Oscar potential. But, at what cost? Should Fanning have taken the role? True, women (even girls) are raped at alarming rates, and to deny this fact just because we’re at the movies might not seem that honest. And, true, any woman (or person, for that matter) can choose (especially with this knowledge) whether or not she’d like to see the film. But what about the people who choose to see the film because of this, who are excited and aroused witnessing the sexualized Fanning’s attack? And what about Fanning, who’s not just baring her body (a la a young Brooke Shields), but who’s vicariously victimized, who consciously knows that “we’re just playing,” but who may somehow still internalize the violence and disempowerment of the scene?

When we value a woman for her body (or, on the other hand, condemn her for it), we’re setting the stage for objectification. There’s a fine line between exposing a female body (as a commodity) and aggressing upon it, and the consequences are even more disturbing when the body is that of a little girl.

Triple Play

This past week, three of the most widely circulated celebrity magazines hit the newsstands, covers beckoning with variations on a theme:

In Touch: “Body Confessions”
US Weekly: “Extreme Diets: Inside Hollywood’s Dangerous Obsession with Being Thin”
Star: “The New Lipo: New Procedure Melts Fat & Tightens Skin in Minutes!—& It’s Affordable!”

I suppose this is more a question than an actual post: In your view, has coverage of eating and body image issues amongst celebrities skyrocketed as of late? I’ve noticed an incredible increase in the amount of attention (on television, in magazines, on the web) devoted to shrinking stars. However, I’m, as you might imagine, more attuned to these now, as part of my research and writing, so I’m willing to accept my hypervigilance as a possible confound. By asking you, I’m hoping to get some clarity—has such coverage increased, or am I just on the look-out?