Stories: Part II

I developed an eating disorder for same reason most other sufferers do. I thought that it worked; I thought that my diet and weight loss were solving my problems. Not a radical belief in this society where weight-loss is touted as the cure-all, food is the ultimate comfort and indulgence, and appearance holds absurd import. The coping mechanisms that snowball into an eating disorder – starving, counting calories, binging and purging – erase shame and guilt, curb feelings of worthlessness, repress confusion and absorb anger. How’s that for a quick fix?

***

My life is about to change drastically. In a few days, I’m moving to a new state, to attend college. I’m leaving my therapist. I’m leaving my acquaintances and my routine. I was only mildly surprised, then, when a few days ago I felt a panicked pining for my old, familiar, sick self. Though my recovery is my greatest and most profound accomplishment, in that moment of panic I needed to see that self: the frail self that deflected all negative emotions; the tiny self insulated from criticism and failure. I tore my room apart looking for pictures. Unlike some survivors I know, I keep few pictures of that years-long period. But suddenly, I wanted to see pictures – I needed to see, again, that it was real.

After a primordially frantic search, I inserted a CD into my computer. Pictures filled the computer screen, one after another. Time stopped; I swam in the digital representation of my past. In one picture, I’m standing in front of a full-length mirror, in my underwear. My upper thighs are no wider than my knees. My chest is a field of ridges and shadows, my bra two flat, droopy triangles. My knee-jerk reaction: that stomach’s not flat! How familiar.

In that picture, my face is hidden behind the camera, which I grip with bony hands. Only the shaded hollow of a cheekbone is visible. That’s what an eating disorder is like: living behind a lens, obscured, clinging to the object of one’s destruction with all of one’s will. No head, no face – the ultimate dehumanization. I needed to share the pictures with someone, to validate my experience; I emailed them to my therapist. “I almost had tears in my eyes,” she wrote back, “to think that that was what you once were.”

***

A very wise friend once told me a story. She’s a larger-than-life character whom I’ll never forget, and this story, thankfully, has stuck with me.

There once was a monastery of monks, high on a foggy mountain in a far-off place where monasteries still exist uninterrupted by documentary filmmakers. The head monk was a prudent and much loved man, but he knew, when his eyes began to curdle with cataracts like frying egg white, and his once pliant hands curled into cold, stiff fists each morning, that he was getting old. It was time to appoint another monk to take his place. To choose his successor, he would submit his monks to the Hall of a Thousand Demons.

There’s a great deal of scholarly controversy surrounding the legendary Hall of a Thousand Demons. Some say its title is more figurative than literal, and the Hall contains only some beasts, a vengeful spirit or two, and a few witchy Slavic peasants. The popular consensus, though, is that the Hall holds one’s thousand greatest fears, infinitely magnified and rendered more real than the beating of your heart.

On a clear evening, the head monk gathered his monastic brothers and explained the task ahead of them. One at a time, the monks would enter the Hall of a Thousand Demons. The monk who reached the back doors of the Hall (and though the head monk seriously doubted that there would be more than one to do so, he figured they’d cross that bridge if and when they got to it) would become the next head monk. The monks nodded. One by one, they entered the front doors, some cocky and strutting, others apprehensive, still others with legs trembling like noodles. And one by one, the monks burst forth from the front doors of the Hall of a Thousand Demons.

“It’s all so real!” they gasped. “We can’t do it! It’s too much!” A defeated crowd congregated around the head monk.

“Ah, my brothers,” the head monk sighed. “Not one of you has cracked the secret of the Hall of a Thousand Demons. With this secret, anyone can pass through. The secret is this: no matter what you see, no matter what you hear, no matter what you feel, just keep putting one foot in front of the other.”

***

The concept of recovery is infuriatingly abstract, especially for a population which tends toward precision and rigidity and control. One of the scariest things about living within the confines of anorexia was my inability – and this seems to be the rule rather than the exception among the eating disorder population – to understand recovery. So I had to have faith. Not necessarily in a higher power – faith in my therapist’s words; faith in my sister’s love for me; faith in my worth as a person, and my capacity to take risks. Faith that I was meant for something greater than this lonely captivity. Like the monks marching through the Hall of a Thousand Demons, the recovering person must persevere, no matter what she sees in the mirror, or feels in her body or mind, or hears from her head. That means unlimited forgiveness and self-acceptance. That means letting go of expectations. That means sitting with uncomfortable emotions instead of fleeing (or starving, or binging). I know very few people who were able to accomplish something so tremendous on their own, and I have unspeakable admiration for everyone who doesn’t give up, who picks up and keeps going.

The saying goes that happiness is the journey rather than the destination, but I take issue in the case of recovering. Recovery isn’t linear progress, and the progress definitely isn’t concerned with happiness. The “journey” of an eating disorder can be full of moments of artificial happiness – the rush, the numbness, the sense of security that comes from dropping pounds, emptying one’s stomach into the toilet or fitting fingers around one’s thigh. An eating disorder is a vaudeville of happiness. Such happiness is not fulfilling, or lasting, or constructive. The more of it that you generate, the more you want next time. So it only makes sense that one would wish to stay in this comfortable fortress, exchanging physical comfort for manufactured emotional OK-ness, rather than leave the fortress and become suddenly vulnerable in so many ways, in pursuit of something intangible and undefined, whose very existence one doubts.

Early in my treatment, I could imagine recovery only as a visual symbol – a great flowing energy. A sort of amorphous life spirit. Getting dressed recently, I caught sight of myself in the mirror – the curve of my spine and my hips, my toned shoulders, my imperfect stomach – and that life spirit is who I saw. Beauty is in the I of the beholder. The I: the being, the identity, the life and energy. My body isn’t perfect. It doesn’t look like anyone else’s – it looks like mine. And my body is perfect because it’s me.

Thought Question

Can you love yourself and hate your body?

Or, in a less extreme version, is it possible to achieve self-acceptance, if you haven't accepted the way you look?

Curious as to your thoughts. . .

Diet Coke

21-year-old Miss USA Tara Conner recently faced the ultimate boardroom challenge--appear before Mr. Trump with the possibility of losing her pageant crown. It seems Ms. Conner has been suspected of alcohol and drug (primarily cocaine) abuse. The verdict? She earned herself a rehab stint but gets to keep her crown.

Just because you test positive for cocaine means you can't be a role model for young girls? Not true (see Kate Moss, Nicole Ritchie, etc.). And, if we're really going to start cracking down on model/celebrity cocaine use, we'll be left with a decimated roster of American royalty--those who remain will likely be a tad more "big-boned" than models past.

So, in keeping Ms. Conner aboard, Trump accomplished quite a bit--he preserved our celebrity culture, reinforced the notion that it's important to do whatever it takes to stay thin (quite discrepant from the idea of substance use in sports), and provided us the opportunity to witness Conner's heartwarming metamorphosis from MADD spokesperson/party girl to recovering addict, reforming her ways and rising above the chaos to bring us all, of course, world peace.

Cada Mujer Tiene un Desorden el Comer

In honor of the upcoming wide release of Dreamgirls, I present to you a
Spanish-language version of an old post I found while browsing on the web. I find this Google-based translation funny, particularly since my Spanish vocabulary is about as paltry as Beyonce's preparatory meals.

Word around town is that Jennifer Hudson's debut is amazing--her performance has been greeted with standing ovations around New York.

Now can we stop talking about her weight?

ED & OCD

In a recent article in the OCD Newsletter, entitled “OCD and Anorexia,” psychologists Eda Gorbis, Ph.D. and Jenny Yip, Psy.D. highlight the striking similarities between these disorders. Obsessive-compulsive disorder (OCD), an anxiety disorder characterized by obsessive thought patterns and/or behavioral (or mental) compulsions, seems to be linked to the restriction and compulsions around food, typical of eating disorders. In fact, it’s estimated that almost half of those diagnosed with anorexia also meet criteria for OCD. Looking at an eating disorder, it’s hard not to see the components of OCD: ruminations about calories consumed or weight gained, compulsive weighing/mirror-checking/exercise, purging as compulsive compensation for a binge.

Both OCD and EDs have been linked with imbalances in the neurotransmitter, serotonin. As such, selective serotonin reuptake inhibitors (SSRIs) are the psychotropic line of defense for both. And finally, similar therapeutic interventions are effective for both. Cognitive-behavioral therapy, which addresses dysfunctional thought and behavioral patterns works quite well in both group and individual settings with each patient population. Exposure and response prevention, a specific behavioral intervention that involves exposure to anxiety-provoking stimuli with the simultaneous prevention of a target behavioral response (e.g., OCD patients might be instructed to “sit with” feelings of contamination while avoiding hand-washing, ED patients might be instructed to “sit with” feelings of fullness after a meal without purging or running to the scale or mirror for self-evaluation) has demonstrated significant efficacy rates as well.

According to Gorbis and Yip, some researchers are considering the idea of subsuming eating disorders under the OCD diagnosis. Taking a look at the criteria for OCD from the current Diagnostic and Statistical Manual (DSM-IV; APA, 1994) below, it seems clear that if we substitute calorie counting, fears of gaining weight, mirror-checking/weighing, and/or bingeing/purging with some of the behaviors provided, we might just have a good fit. One notable difference is that described under criterion B, which suggests that in OCD, the obsessions or compulsions are recognized to be unreasonable. In some eating disorder constellations, particularly those that are more restrictive in nature, it seems that this criterion may not be met.
______________________________________________________
A. The Person Exhibits Either Obsessions or Compulsions

Obsessions are indicated by the following:
1) The person has recurrent and persistent thoughts, impulses, or images that are experienced, at some time during the disturbance, as intrusive and inappropriate and that cause marked anxiety or distress.
2) The thoughts, impulses, or images are not simply excessive worries about real-life problems.
3) The person attempts to ignore or suppress such thoughts, impulses, or images or to neutralize them with some other thought or action.
4) The person recognizes that the obsessional thoughts, impulses, or images are a product of his or her own mind (not imposed from without as in thought insertion).

Compulsions are indicated by the following:
1) The person has repetitive behaviors (eg, hand washing, ordering, checking) or mental acts (eg, praying, counting, repeating words silently) that the person feels driven to perform in response to an obsession or according to rules that must be applied rigidly.
2) The behaviors or mental acts are aimed at preventing some dreaded event or situation; however, these behaviors or mental acts either are not connected in a realistic way with what they are designed to neutralize or prevent or are clearly excessive.

B. At some point during the course of the disorder, the person has recognized that the obsessions or compulsions are excessive or unreasonable. (Note: this does not apply to children.)

C. The obsessions or compulsions cause marked distress, are time consuming (take more than 1 hour a day), or significantly interfere with the person's normal routine, occupational/academic functioning, or usual social activities or relationships.

D. If another Axis I disorder is present, the content of the obsessions or compulsions is not restricted to it (e.g., preoccupation with drugs in the presence of a substance abuse disorder).

E. The disturbance is not due to the direct physiologic effects of a substance (e.g., drug abuse, a medication) or a general medical condition.

Size Ate

Size Ate is a one-woman show that captures playwright/actress Margaux Laskey's struggle with eating and body-image concerns. I stumbled upon the show last year and was immediately struck by the sincerity of her story and performance. I contacted Ms. Laskey after seeing Size Ate and talk of professional collaboration ensued. Here is Ms. Laskey's promotional video for Size Ate:



Not too long ago, Ms. Laskey asked me to write a blurb for her promotional materials. Here it was:

I saw Size Ate twice and enjoyed it both personally and professionally. Margaux Laskey is a talented actress (and singer) who has penned a touching, autobiographical piece that is alternately funny and serious, personal, insightful, and most of all, heartfelt. While I believe Ms. Laskey’s performance would be enjoyable to any audience, I would especially encourage women who struggle with eating and body-image concerns to see this show.

It's possible that Size Ate may go on tour--for now, the greater possibility is another NYC run. If so, I invite you all to come join me in New York for some hot chocolate and a healthy dose of introspective theater.

A New Blog in Town

Sandy Szwarc, a registered nurse (and researcher), recently sent me a heads-up on her new blog, "Junkfood Science." I've had a chance to review it and have found her presentation of research informative and accessible and her message congruent with mind/body health. The site tackles body/weight issues, but also provides a wealth of information on food science and health policy concerns.

Sandy's blurb: "Junkfood Science -- The truth about food, fat and health. It's not what you’ve been led to believe. Learn the science that mainstream media doesn’t report and how to critically think about the junk they do that's not fit to swallow."

Check it out.

Cultured?

This past weekend's The New York Times Magazine features an article written by a Harriet Brown, the mother of a 14-year-old girl diagnosed with anorexia. Ms. Brown's personal account of healing her daughter describes the Maudsley approach, a family-based approach for treating anorexia, and pays tribute to the genetic factors associated with eating disorders. Brown cautions us against socio-cultural explanations: "If this were true, though, millions of American girls and women would become anorexic instead of the roughly 1 to 3 percent who do. Clearly there are other factors involved." Brown's point is well-taken--a number of factors have been associated with the development of eating disorders; however, when you turn the page after the article's end, it's hard to discount the critical role that cultural images and dialogues play in women's thoughts about their bodies.

(Lest there be any uncertainty, the image illustrates a Times feature subtitled, "An Artful Homage to this Season's All-Important Acessory: The Hat.")

Calorie Restriction

(from The New York Times: two rhesus monkeys about the same age, one fed a CR diet,left, the other fed a normal diet)

A number of people have asked about my thoughts on calorie restriction, the movement that follows the notion that the less you eat, the more years you’ll live. The idea is that giving up those hearty meals, those decadent treats, those full-plate or even half-plate servings, you may up your chances at living a longer, healthier life. And, so on the almost-eve of America’s national overeating challenge, I offer some thoughts on calorie restriction. Please keep in mind that these observations/interpretations are from a psychological, not nutritional or biomedical perspective, and that the fact that a clipping on calorie restriction (CR) that I had saved for this post just caught fire on a candle I’m burning at my desk does in no way reflect on my thoughts about CR.

CR involves consuming about 30% fewer calories per day than is generally recommended for one’s height, weight, and body type. The key, though, is that amounts of vitamins, minerals, and other essential nutrients are kept constant (or even enhanced), resulting in a kitchen laboratory of sorts, where scales, measures, and computer monitoring ensure adequate levels of nutrients on a largely barren plate. From what I understand about nutrition, this may not be the easiest task.

Support for CR dates back to 1935, when Dr. Clive McKay, a researcher at Cornell University found that rats fed a CR diet lived approximately 40% longer than their normally-fed counterparts. Similar results have been found in primate populations, where like in mice, scientists are seeing reduced incidences of diabetes, heart disease, cancer, and other ailments with the introduction of CR.

Does CR work in humans? They’re not so sure. The truth is, the scientific community isn’t exactly sure how CR works at all. Still, several hundred thousand people have swapped their cookbooks for cooking scales, their large serving plates for the ceramic equivalent of “just a little bit.” A New York magazine article focuses on Michael, a bona fine calorie restrictor, who at 6’ feet tall and 115 pounds consumes 1,913 calories per day. Exactly 1,913. His dinner, his girlfriend (also a CR devotee) explains, is “‘always 639 calories.’” Other CR followers profiled in the article skip meals or consume a single meal per day.

A New York Times article reports that scientists at Washington University who have studied a group of calorie restrictors have found that “the dieters had better-functioning hearts and fewer signs of inflammation, which is a precursor to clogged arteries, than similar subjects on regular diets.” According to the Times, research published in JAMA has also suggested that those on CR diets have lower body temperatures, lower insulin levels, and fewer indices of chromosomal damage linked to the aging process.

On other hand, the Times reports that:

A mathematical model published last year by researchers at University of California, Los Angeles, and University of California, Irvine, predicted that the maximum life span gain from calorie restriction for humans would be just 7 percent. A more likely figure, the authors said, was 2 percent.

Is it really worth it, to give up (for a lifetime) the decadence, the luxury, the indulgence of food for an extra couple of years? One of the paper’s authors, Dr. Jay Phelan at UCLA says: “‘Calorie restriction is doomed to fail, and will make people miserable in the process of attempting it.’”

As with many enterprises (especially surrounding food and weight), the research may be confounded. People who subscribe to CR are likely to be those who don’t smoke, who don’t drink to excess, who exercise, and who generally engage in a host of other behaviors designed to promote their health. Their results on medical tests do not indicate that CR is ultimately responsible for their good health.

Regarding Phelan’s point above, it’s unclear what the long-term effects of CR in human populations may be. From a psychological perspective, CR does not look much different (at least superficially) from a weight-loss diet. For those who are approaching CR for weight-loss purposes, we may see similar failure rates to other organized approaches that focus on deprivation. CR also looks a lot like the restriction associated with anorexia. Those involved in the CR movement emphasize that the goal is not weight loss and that nutrition takes a paramount role, unlike in anorexia. The Calorie Restriction Society takes a special look at CR vs. anorexia here. Still, eating-disordered thoughts and behaviors may creep up on the unsuspecting CR follower, particularly someone who focuses primarily on the associated weight-loss benefits. We may also see, as Phelan indicates, difficulty adhering to CR and compensatory bingeing, as a result of hunger and a reaction to a constricting, depriving diet without an end in sight.

Your thoughts?

More or Less

In most aspects of life, we’re always yearning for more: more time, more money, more love, more knowledge, more space, more insight, more sleep, more hope, more light. With regard to weight and shape and size, however, less is more—to weigh less; to have a smaller frame; to approximate zero as best we can; to come, in some cases, as close to nothingness as possible, while still claiming to exist.

“I want to be less.” Deconstructing the sentence, it’s interesting how it maintains meaning as it shrinks:

I want to be less.
I want to be.
I want to.
I want.
I.
.

For women, how did less become a synonym for more?

VCR/DVR Alert

Tomorrow night at 9pm ET, HBO airs Thin, a documentary on eating disorders by filmmaker Lauren Greenfield. Click here here for an interview with Ms. Greenfield.

The Fault of the Fat

As if having to endure public ridicule and self-reproach weren’t enough, now the obese population is being blamed for one of our planet’s most harrowing crises—global warming. The New York Times recently reported that in an issue of The Engineering Economist, researchers calculated the extra gasoline costs use to transport our growing nation, to the tune of a billion gallons per year. Similar research regarding airline fuel use was published a year earlier in The American Journal of Public Health, which suggested that the extra 10 pounds Americans now schlep around is responsible for 350 million gallons of fuel, resulting in significant increases in environmental carbon dioxide.

So, does the drama of global warming tip the scales to the point where the obese population will finally have an a-ha moment, the personal turning point, when sudden insight leads to miraculous weight-loss? Not really. As the Times reporter Gina Kolata notes, “It’s not that the obese don’t care. Instead, as science has shown over and over, they have limited personal control over their weight. Genes play a significant role, the science says.” And, we know what typically happens when we raise the stakes in the obesity game—those stigmatized, blamed for their personal (and now environmental and sociopolitical) ills and compelled to lose weight will actually. . . eat more. It’s akin to yelling at a stuttering child. What do we think is going to happen?

So far, scholars are also not taking bait. In the Times article, Kelly Brownell of the Rudd Center for Food Policy and Obesity at Yale says, “‘People are out scouring the landscape for things that make obese people look bad.’” Katherine Flegal of the Centers for Disease Control and Prevention offers a tonge-in-cheek response: “‘Yes, obesity is to blame for all the evils of modern life, except somehow, weirdly, it is not killing people enough. . . . In fact, that’s why there are all these fat people around. They just won’t die.’”

Addictions

I’ve been thinking a lot recently how eating-disordered thoughts and behaviors mimic other addictions. Just like a drink or drug, an eating-disordered action can be compulsive (or impulsive), can rescue us (temporarily) from difficult feelings, and can create a host of new problems that obscure what originally led us to these behaviors in the first place.

With addictions, we often use functional analyses to understand the patterns associated with alcohol/drug use. In its simplest form, a functional analysis looks like this:

Triggers-->Behaviors-->Consequences

That is, certain situations or events lead us to respond in a certain way, and these responses have various consequences. With alcohol/drugs, we often focus on the triggers (people, places, things) that lead us to drink/use (or not), and the positive and negative consequences of using (or not). To apply this to eating-disordered behaviors, we first need to identify the behaviors in question. Here are some examples:

1) Restricting
2) Bingeing/purging
3) Emotional eating
4) Excessive exercise
5) Excessive weighing/mirror-gazing
6) Engaging in critical thinking about our bodies
7) “Feeling” fat
8) Desperately turning to the next diet

As for triggers, to expand upon people/places/things, they are often thoughts we have, emotions we experience (the concept of “emotional eating” itself addresses 2/3 of the equation above), stimuli we encounter (e.g., a fashion magazine, gaining weight/losing weight, a picture of ourselves, a bad day), physical symptoms (e.g., feeling overly full, tense, lethargic), etc. What other triggers do you experience?

Once we encounter these triggers, we have a number of behavioral responses that we may employ (some repertoires may be larger than others). For the purpose of this discussion, the critical distinction ultimately occurs between engaging in an eating-disordered behavior (see above) or not, instead relying on a more adaptive coping resource. Each option is associated with consequences, good and bad. Bingeing might make us uncomfortable, but having access to unlimited, tasty food feels good in the here-and-now. Berating ourselves for the size of our stomachs may cause us to experience anger or grief, but it potentially distracts us from even more uncomfortable thoughts and feelings. Examining some of the other consequences—good and bad—of engaging in these behaviors may help elucidate our decision-making processes.

Cheers!

Recent research out of Harvard Medical School and the National Institute on Aging suggests that an ingredient found in red wine, resveratrol, may reduce the incidence of the health-related consequences typically associated with obesity. When obese mice were administered heavy doses of resveratrol, their fat-related deaths dropped by 31%.

As for the resveratrol-enhanced mice? “‘They’re chubby, but inside they look great,’” says study co-author David Sinclair of Harvard in a Metro report. Sinclair’s co-author, Rafael de Cabo, with the National Institutes on Aging, states in a Harvard Medical School News Release, “‘After six months, resveratrol essentially prevented most of the negative effects of the high calorie diet in mice.’”

Preliminary results indicate that resveratrol may be associated with lower incidences of diabetes, heart disease, and liver dysfunction, even in obese populations, when the prevalence of these diseases, historically, has been thought to be directly related to patients’ weight. Again, we’re confronted with data suggesting that it’s impossible to posit a one-to-one correlation between weight and health, that a multitude of factors (e.g., physical fitness, genetics, even mass amounts of red wine consumption) may moderate this relationship.

BMI Not TMI

A little more on the BMI: The index was “invented” by Belgian man named Adolphe Quetelet, who’s identified as a “polymath.” I’m not exactly certain what a polymath is, but it sure doesn’t sound fun.

During the course of this writing, Lancet medical journal published meta-analytic research (of 40 studies) out of the Mayo Clinic suggesting that those with too-low BMIs were at greater risk for heart disease-related death than those who had BMIs in the normal range. Moreover, those considered “overweight” by classic BMI standards actually had a higher rate of survival (with fewer heart problems) than those in the “normal” BMI range.

Head researcher Francisco Lopez-Jimenez says “Rather than proving that obesity is harmless, our data suggests that alternative methods might be needed to better characterize individuals who truly have excess body fat compared with those in whom BMI is raised because of preserved muscle mass.”

It took the Mayo Clinic until 2006 to come up with this? Our gold standard isn’t so golden, after all.

In another article in the same issue of the Lancet, Maria Grazia Franzosi states, “BMI can definitely be left aside as a clinical and epidemiological measure of cardiovascular risk.” Instead, it seems that waist-to-hip ratios are, for now, the way to go. And Grazia Franzosi’s research suggests that these ratios are good prognostic indicators of cardiovascular health. Still, we seem glued to a number (from pounds to BMI to ratios) that is, at best, a gross estimate of an individual’s unique biology. When it comes down to it, it’s easier to address a number than a person.

The Last Supper

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

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

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

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

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

Celebrity Chatter

In November’s issue of Self magazine, Lost star Evangeline Lilly, 27, reports that, after a recent stint of undereating and over-exercising, she realized, “‘I didn’t have an eating disorder, but I was pushing myself too hard for the calories I was taking in, and it wore down my immune system.’” Now, Lilly has dropped her three-hour daily workouts down to an hour, and is “‘not depriving [her]self anymore.’” But, there’s still a psychological struggle:

“I’ve always hated that my hips are smaller than my thighs, but I also take pride in that, because I want to be somebody who young women can look at and go, ‘Ok, she’s not perfect, so it’s OK if I’m not either.’”

Kudos to Lilly for recognizing (and avoiding) the entrance to a slippery path and for recognizing her role-model potential. Will it really make a difference? A recent issue of In Touch Weekly quotes Lilly as saying, “‘I come from a family of women with big thighs,” and notes that her workouts can “go a long way toward smoothing her lumps and bumps.” Other celebs targeted in the same “Even Stars Have Cellulite!” feature: Scarlett Johannson, Mischa Barton, Christina Aguilera, Kate Moss, Jessica Simpson, Uma Thurman, and the Hilton sisters.


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

Weightstaff

Everything, everything has to be about weight.

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

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

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

Stories: Part I

With permission. . .

INTRODUCTION

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

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

None of that is true.

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

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

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

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

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

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


WHAT HAPPENED

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

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

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

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

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

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

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

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

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

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


WHAT I DID ABOUT IT

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

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

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

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


THE REALIZATION

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

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

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

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

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

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

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

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

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

I was stuck. But not anymore.


THE FUTURE

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

I'm done playing.

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

EWHAED Salutes Dove

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

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

Fashion Forward

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

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

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

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. . . .