Too Fat, Too Thin, What's a Girl to Do?

Did you happen to catch this?

Is it a step in the right direction (that we're more accepting of a healthier size and newly critical of "too-thin") or do the results just represent more of the same judgment and criticism of women's bodies, when we should be focusing on something else? (e.g., Holmes reportedly was a Broadway success) What do you think?

Student Health

Karen, over at Some of My Other Random Thoughts, emailed me an excerpt from one of her recent posts. Check it out:

Last week, I went to the student health center to get an allergy prescription. I'm a grad student and student health is free! I still have to pay for the prescription because I don't have health insurance for the moment, but the appointment is free! Maybe you get what you pay for, because it was a weird little experience that I've probably retold to five or six different people in the last seven days.

The nurse had me step on the scale in the hallway. I did, and watched the number appear, all digital style, the same number I've been frowning at when standing on the YMCA scale, jiggling the non-digital balance thingy, hoping it'll bounce up, er, down, a little.

The nurse, on the other hand, was shocked at the number. Not because she knows me (never seen her before) or saw that I'd gained a significant amount since my last visit (I haven't) or was even looking at my chart. She was shocked because, as she put it, "Wow. You do not look like you weigh that much!"

I chuckled or snorted or something, perhaps slightly uncomfortable, but not hearing the alarm bells that later reflection told me I should have heard. My people-pleasing kicked in, and I said, with a little slap to my, ahem, outer thigh, "It's all in my hips!"

"Seriously," the nurse continued, unable to impress this upon me with only one inappropriate comment, "You do NOT look like you weigh that much."

Heh, heh, I might have said. I went into the room, briefly chatted with the doctor, got my script, and I was gone. It wasn't until after class, on my hour-long drive home, that I thought, Huh. Something was not right about that.

I probably should write a letter to the medical director, as more than one of my post-event confidantes told me. I should probably include in that letter that no staff member should ever comment on a woman's (or any patient's) weight while weighing them and writing the number in the chart. If a comment needs to be made, as it might, about significant gain or loss, or concerns about medical complications, it should be made by the primary provider, in a sensitive, confidential way.

Here's the thing. I think she thought she was complimenting me. "Wow, you look skinnier than that number!" or "Wow, you look like you weigh ten pounds less!" But isn't there also a subtext:
"Wow, that's a high number!" or "Wow, you don't look that fat!" And what about this? What if I were recovering from or still dealing with an eating disorder? This is university student health. I know I'm 36 and don't flatter myself that I look 18, but eating disorders have been around since my college days. If it bothered me, who has never been particularly obsessed or concerned about my weight, what would it have done to someone who was finally at a "normal" weight after years of anorexia or bulimia. What if I'd heard negative things about my weight through my whole life from my mother or other important role models? (And isn't that A LOT of women?)

Reactions to Karen's experience?

What If?

From the talented Gavin DeGraw:

I don't want to be
Anything other than what I've been trying to be lately
All I have to do
Is think of me and I have peace of mind
I'm tired of looking 'round rooms
Wondering what I've got to do
Or who I'm supposed to be
I don't want to be anything other than me

I wonder what would happen to the incidence of eating disorders if we could all grab hold of this. . . .

Seriously, Kristen?

You may recall seeing actress Kristen Johnston drop an alarming amount of weight this past summer. Reports vary, but it seems Ms. Johnston lost something in the neighborhood of 40 (or 60?) pounds, which she attributes, in various media reports, to experiencing a burst ulcer. Skeptics suggested that, instead, she struggled with an eating disorder, but it's important to keep in mind that we have no clear confirmation either way (unless some reader of this blog is either her therapist or her gastroenterologist and is willing to breach patient confidentiality in order to clear up any misunderstandings).

But here's my concern. . . . Recently, on TMZ (I know, not the best news source, nowhere near the caliber of responsible journalism typical of People or Page Six), Johnston reported she had no idea she had lost the weight. Hold on a sec--she had no idea she lost 40 pounds? Even if she never set foot on a scale, wouldn't she maybe have had a moment where she tried on a pair of jeans and had said pair fall directly to the floor? How can you not know you've lost 40 pounds? What was the thought process as her clothing fell off her then emaciated frame? "My personal assistant must have secretly taken my wardrobe to the tailor and had everything taken out, why I don't know, but, yes, that's clearly what must have happened"?

*Please vote on the title if you haven't already. Your input is tremendously important to me--I'm even curious what you think about the results so far. . . .

Back to the Beginning

I'm starting to think about seriously shopping around my book and wanted your opinion. A while back, I asked about my working title and wondered about other possibilities. I thank you all for your suggestions--I just offered some in a poll (scroll down and look to your right). I'd appreciate your feedback, and if it's "other," please feel free to comment here with your idea.

Bridal Wars

Dropping weight for your upcoming wedding? Planning on it? In the current issue of Modern Bride, Abby Ellin tackles the phenomenon of the newly betrothed (many who are already quite thin) taking extreme measures to lose weight before their big day. The proliferation of bridal boot camps and Bulging Brides reinforce the idea that no matter how thin you are, you must be thinner to walk down the aisle. Check out the article if you get a chance--Ellin effectively covers an alarming trend that has become the norm and, to my excitement, quotes me!

The New Yorker Article

Did anyone happen to catch this? If not, give it a read. I know it's supposed to be funny, I really do, but I still felt compelled to comment on a few points. See my letter to the editor below:

Dear Editor:

As a clinical psychologist specializing in eating disorders in private practice here in NY and at Columbia University Medical Center, I took great interest in Amy Ozol's "Looking Your Best" (in the January 5th issue). To be clear, I understand that most of what Ms. Ozol writes she writes in humor, and psychologists of all people understand the importance of maintaining a sense of humor. Still, there are some statements that cross even that line--if I had a dollar for every time I tell a layperson I specialize in eating disorders, that someone says, "Oh, I wish I had anorexia," I'd be looking toward early retirement.

Ozol's piece is funny and offers a number of truths related to healthy weight-loss or -maintenance. However, there are a couple of objections I have that I believe fall beyond even the clearly humorous spirit of the piece. Ozol mentions visualizing eating food and spitting it out as a possible weight-loss technique. Frequent chewing and spitting is actually an eating-disordered behavior and would be clinically diagnosed as Eating Disorder Not Otherwise Specified.

Ozol also recommends using psychotropic medications in order to allay distress associated with emotional eating. This is, in fact, helpful for a number of patients. But, what Ozol fails to mention is how closely linked disordered eating and substance abuse are. Commonly, patients replace one set of behaviors with another, so there is concern for abuse potential of psychiatric medications, particularly when the classes of medication prescribed are addictive (such as benzodiazepines, including popular drugs like Xanax, Klonopin, and Valium).

As another recommendation, Ozol suggests surrounding yourself "with thin people." Unfortunately, there happens to be a lot of competition (particularly between women) around weight. Again, Ozol is using humor, recommending gastric bypass surgery in order to correct a discrepancy between friends. But beyond this, it's important to realize that competition between women can have deleterious effects on mood and self-esteem (and on relationships between women and even our standing in the world), consequently even causing, in some cases, the emotional eating to which Ozol refers earlier on.

Finally, Ozol reflects on the relationship between weight and socio-economic status when she writes about donating "fat clothes" to charity: "Refrain from donating anything to charity, as this could cause underprivileged people to become obese, which would be unsavory and possibly even illegal." Funny, yes, but also inaccurate--the percentage of low-income individual who are fat is quite high--related possibly to genetics, insufficient access to unprocessed foods and balanced meals (a meal from McDonald's is cheaper than one from Whole Foods, right?), and a lack of time and access to participate in physical activity. This truth, too, is lost in Ozol's comic recommendations.

Oh, O

I know, I know, y'all want to hear more about Oprah's weight gain. In the latest issue of her magazine, Oprah asks: "How Did I Let This Happen Again?"

I don't want to point any fingers, but maybe, just maybe, it has something to do with this. When are we all going to figure out that if diets are imprisoning, cleanses are the solitary confinement of food restriction? Is there anyone out there who's cleansed without, when all's said and done, gaining any compensatory weight? A cleanse is too restrictive to live by, and the body and mind inevitably rebel from a period of deprivation.

Still, I hate to talk about her weight. I hate that she's talking about her weight. She's one of the world's most powerful, influential women, and the most newsworthy item about her is what happens when she steps on the scale?

Fat Tax

And, what do you think about this?

Hello, Skinny!

There's a big sign in the contemporary jeans section at Bloomingdale's that, in an ode to the skinny jeans trend, reads: "My Skinny Is Skinnier Than Your Skinny."

Um, ok. . .

I googled the phrase to find out more about this particular advertising campaign and serendipitously stumbled on this.

Thoughts?

Book Review

I just finished Such a Pretty Fat: One Narcissist's Quest To Discover if Her Life Makes Her Ass Look Big, Or Why Pie is Not The Answer and wanted to discuss it here. Author Jen Lancaster also penned Bitter Is the New Black and Bright Lights, Big Ass (have you read them?), but it was this title that grabbed my attention at the local book store.

Quick disclaimer--for those with clinical eating disorders, this book could be triggering, as Ms. Lancaster's book deal is based upon her losing weight. For the "Every Woman" variety, I don't believe this piece will be triggering, but rather that you'll find yourself identifying with much of what Ms. Lancaster has to say. To be clear, it's kind of a diet book, but it's an anti-diet, diet book. You'll see what I mean. . . .

What surprises me most about her book is Ms. Lancaster's general acceptance of her weight (at any size), her ability to take weight gain in stride, and her sense of humor about it all. All this despite some challenging formulative experiences:

My mom was so damn mad at me after my freshman year, especially once she saw me in a bathing suit for the first time. I went from 135 pounds to 150 and you'd have thought I'd flunked out given her reaction. She always used to tell me her greatest fear was that I'd walk across the stage at my high school graduation overweight. Really? I remember thinking. With forty girls in my school who'd either gotten pregnant or had babies, this is her issue?

In reaction to her parents beginning officiating weekly weigh-ins, Lancaster writes:

I desperately hated the whole process, especially because I had no choice in the matter. I knew being heavier didn't change who I was, and I was furious at being forced to alter something about which I felt perfectly fine.

How many college students do you know with this kind of persepctive? More to the point, how many full-grown adults can say this for themselves?

When Ms. Lancaster begin her weight-loss journey (the point of this particular book deal), she weighs herself a couple of times in disbelief:

I trot down the hall--which I can do because I'm not completely obese--and try to calm myself down. I'm totally overreacting here. I am fine. I know I'm fine. Whatever I weigh is just a number. I'm fun and smart and I can perfectly blend three shades of eyeliner. I enjoy my own company and I make myself laugh. I dress well, even on a budget while wearing Crocs, and no one makes a banana daiquiri like I can.

I suppose it's not that surprising that she was alarmed by her weight--she chooses to focus on so much more. I find her attitude incredibly refreshing, particularly in a current cultural context that demands we focus on looks at the expense of all else.

Lancaster writes about our obsession with thin celebrities:

[Nicole Ritchie] really didn't get famous until she got pin thin. Ditto Kate Bosworth and Lindsay Lohan. And no one would have even remembered Mary Kate Olsen if she'd just eaten a sandwich once in a while. This makes me wonder how much the media plays into the self-image of [dieters]. Did they call Jenny because fashion and gossip magazines force photos of hungry women down our throats and try to make us believe their boyish bodies are the ideal? If so, we're all destined to fail.

Personally, I never want to be as thin as most of the women in this magazine; they look gross to me. The only ribs I want to see are covered in barbecue sauce.

Ms. Lancaster has had her share of weight-loss experiences, illustrating why diets don't work:

Consuming a thousand calories a day with very little protein, I felt lightheaded and weak every second for three whole months. I wasn't just hungry. I was famished. Starving. Ravenous. Not only did I want to consume my parents' cooking in vast quantities; I was in such a state that I'd look at the love of my life, a 140-pound Great Pyrenees mountain dog named George, and I'd fantasize about his tender, meaty flanks, charbroiled over a hickory-wood fire and served with a side of home fries.

Perhaps most illuminating is Ms. Lancaster's realization that food restriction can work against us. She chats with a friend:

"Funny, but when I'm not dieting I can go hours and hours without thinking about food. Some days when I'm busy it might be four in the afternoon before I remember to eat something. But now that I'm doing Atkins*, all I can think about are bagels and donuts and Lucky Charms cereal, and I'm making myself crazy."

(Spoiler alert)

In the end, Ms. Lancaster does lose some weight, and it's no surprise how. But, if you read closely, you can't help but realize that her weight-loss is just another life task for her (like writing a book, or learning a skill), accomplished with curiosity, humor, and positivity, the inspriational outcome atypically disengaged from her self-esteem.

*I had a typo on "Atkins" and guess what? Spellcheck on Blogger corrected it for me.

More on Thanksgiving

An email advertising this post-Thanksgiving day workout arrived in my inbox last week. Sure, exercise is an important part of a healthy lifestyle, but can you can you identify any problems with an advertisement like this?

On Thanksgiving

Recently, I overheard the following exchange:

"What are you doing for Thanksgiving?"

"We're going to the so-and-so's. They're having 20 dishes. It's disgusting. I'm going to bring a salad for myself."

I read somewhere that Americans consume an average of 4,500 calories at their annual Thanksgiving meals. As we all know, what began as a feast of gratitude has morphed into a national binge. Many people report feeling uncomfortably full after their meal. Sure, we all eat past fullness on occasion, but the culturally sanctioned degree here is cause for concern, as nausea trumps satiety with the rationale that we're all in this together.

In response, especially for people who struggle with disordered eating and body image, there's Thanksgiving day anxiety. . . or disgust. 20 dishes? That sounds like a smorgasbord of wonderful opportunity--a chance to sample a little bit of this, a little bit of that. But, because we don't trust ourselves to do this, because we see such occasions (similar to cruises) as respite from the shackles of dieting, we go overboard.

So, where does moderation lie? Somewhere between 4,500 calories and carting along a salad as armor against the spread. . .

Have You Gained Weight?

Several weeks back, I attended a therapy conference, one that meets several times a year. Because of I've been to a few of these, I've come to know some of the members of this particular group. On the first night of the conference, I ran into another psychologist. I smiled at him as we passed each other in the hall and he said, in greeting, "Have you gained weight?"

Sigh.

No one at this conference knows about my EWHAED idea, so I decided to broach the topic the next day. When we met in a smaller group, with said colleague included, I mentioned how he had greeted me the night before and why this struck a nerve. Outside of a moment of snarkiness (which I feel obligated to report), I explained to him why the focus on weight is troubling to me, why it is troubling to all of us.

"Did you stop to think I was noticing your body?" he explained.

Yes, I did. Not helping.

"I just remember that when I met you last year, you were training for the marathon."

Still not helping.

I explained to the group that this reinforces the idea that women are noticed/judged for their bodies at the expense of other attributes. And, then, I said what seemed to shock the group the most, something I've written here before: "By the way, I also don't want you to ask if I've lost weight."

"Then, what are we supposed to say?" another male colleague asked, clearly frustrated by the parameters I set.

"Nothing! You don't need to say anything about my body or about the way I look. I can connect with you in so many ways, outside of my appearance. Can't we focus on that?"

I think I eventually got my point across, but I'm still marvelling at how difficult it was to make, ironically, in a room full of mental health professionals. Should I have taken on this battle? What would you have said?

Pretty Girls

Recently, I saw a play, containing a line of dialogue that sparked a lot of thought. The female lead character announced (paraphrased, I believe): "All little girls should be told they're pretty, even if they aren't."

Questions: 1) Should we routinely tell our little girls they're pretty? 2) Should we do this even if they're not? I'm curious about your take. . . .

Stories: Part V

A reader named Stina recently sent me a letter, entitled: "Edie, Me, and the Whole Dang World":

Dr. Stacey,

I'm a newlywed, married to a man who still gives me butterflies, who adores every bit of me, and who I know would do anything to make me happy. I have a job that many people envy, and most wouldn't consider work at all. I live in a house that is lovely and perfectly-sized. I have two cats that I treat like children. I have a great family. My close friends are incredible. I have all this. . .but I'm still unhappy.

How is this possible? What is it that makes me unhappy? What do I still crave, and what is holding me back?

It's not a what, but a who. And her name is Edie. And what do I crave? To be rid of her.

Your blog has helped me re-connect with fighting her and learning to live a life free of her incessant, caustic remarks. I came across your blog as I was searching for validation for my frustration at our general society as a whole. The magazines that woman are suppose to be drawn to (because they talk about issues we. apparently, deem "important") bombard us with contradicting messages, so that even if we were trying to be happy and healthy (as so many magazine shove us the secrets and tools on just how to do this) they fill it with pages critiquing the weight of someone and the weight loss of someone else. Even magazines whose sole purpose is to show us how to treat our bodies better - like, Self, for instance - stuff their pages with diet pills and ads, giving us the option of either listening to their latest exercise regime, or finding the quick fix in a supplement pill.

I'm tired of it all, and most of all, I'm tired of the pressure I've placed on myself to meet those standards. I invited Edie into my life so I could get to that ideal - that perfect size so I could have the perfect life. She has been with me for 11 years, and instead she has given me misery.

I'm not sure when Edie and I first met. I remember an aunt of mine, who I always noticed was incredibly self-critical of her own weight and looks, once looked at my nine-year old legs and declared dejectedly, "You have the family thighs too." I knew she did not mean this as a compliment and began looking at my legs in a new way. I hadn't truly noticed the flaw in them before, but I always felt felt something was different about me - and not in a good way. And perhaps now I had an answer - it was my huge thighs!

Maybe it was then that Edie came into my life. She was almost transparent at first, I hardly acknowledged her, but I acquiesced her judgments and resigned them as "help". She would tell me secrets on how to be more popular, for more people to like me, and let me in on the reasons why people did not like me: I was not pretty enough. And the only thing holding me back was my weight.

Edie continued to hover by my side through the rest of my life - popping in on nights of big occasions - like prom - examining my stomach and showing me how to position my hands in pictures to cover the rounded area. She was there when bad things happened - like when I broke up with my first real boyfriend. She knew the perfect way to get back at him was to show him he meant nothing, to look better than I ever did, and the only way to do that was to throw up any morsel I ate, so no fat would linger on my body.

She was there, constantly with her critiques, her thoughts, her non-stop chatter about my body and my weight and my looks - pushing me to be better, encouraging me to punish myself if I ate too much, and chastising me for thinking a boy thought I was cute. Impossible, she would whisper. You're too fat to be cute.

And then I met my husband, who Edie hates. I met him and he told me Edie was crazy - that I was, in fact, gorgeous, that I was smart and intelligent and funny, and that was all me - Edie didn't create that.

The more I listened to him, the more Edie screamed at me to listen to her. She fought with me bitterly to keep me all to herself, but she didn't win. I married that man, and learned to tune her out or at least quiet her dismay. I spent my whole wedding and honeymoon without her, and it was amazing. But, it's as though now I'm back in the "real world", where true happiness can not last because I am not a size 2, I do not have a flat stomach, and my thighs are not sticks. Looking back at wedding pictures, her voice is still there, complimenting me on how I held my bouquet to disguise my stomach, and shaking her head disdainfully at the pictures of me eating cake.

Edie never really left, and Edie never will. I will live my whole life with an E.D. (eating disorder) and I've got to find a way to really learn to live without listening to her - without giving strength to her thoughts. I want to thank you for your blog for helping me to continue on my journey, to know that I am not alone with wanting to not only change myself, but change the world -especially for all the young girls that are about to find out from society that they just aren't good enough until they disappear.

After writing this, Stina decided to start her own blog. You can stop and say hello here.

News Feed

Thanks to the EWHAED news sleuths who forwarded me these:

1) The concept of fining overweight athletes--what do you think?

2) Think your flu-induced weight-loss must be temporary? Think again. Reactions?

Ending Fat Talk

Check out this new video from the sorority, Delta Delta Delta.

Love it.

NYC Menu Labeling

A colleague and I are working on an article about New York City menu labeling laws--if you live in NYC, you probably already noticed calorie counts posted on in-store menu boards. Menu labeling is now a law--restaurants with 15 or more locations nationwide are required to post calorie counts.

For now, I'd like to look at a number of assumptions inherent to menu labeling laws.

1)Consumers don’t already have an idea about the caloric content of their favorite foods: Those most likely to respond to calorie postings likely already have a sense about the nutritional information of the foods they’re eating. They’ve read the pamphlets or scoured the internet in order to reduce their caloric intake. In-store menu labeling may encourage consumers to base more and more of their food decisions on caloric amounts, leading to greater food restriction, a pathway to clinical eating disorders. For those who already struggle with eating disorders, menu labeling can be emotionally triggering, as patients in recovery work quite diligently to remove their shift from calorie counting.

2)Consumers are concerned about caloric content and will choose lower calorie foods: Another subset of consumers represents those that typically eat higher calorie diets, enjoy their dining out, and aren’t particularly interested in calorie counting. Customers at fast food restaurants, for instance, are often driven by taste and cost, and likely won’t be swayed by caloric labeling.

3)Reducing calories is the only way to promote healthier eating: Another pitfall with caloric labeling is that only the calorie count is posted. Therefore, there is a potential for consumers to choose lower calorie foods, while disregarding other variables such as protein, carbohydrate, fat, and fiber content, along with the host of vitamins and minerals that certain foods contain. An eight-ounce glass of skim milk is more caloric than a similarly sized serving of Diet Soda, but the milk is more nutritious.

4)Consumers will be able to sustain a lower calorie diet, requiring them to sacrifice what they prefer to eat: It’s estimated that over 95% of all diets fail, as humans do not respond well to the experience of deprivation—whatever weight is lost through dieting is often regained (and then some) as we compensate for a period of deprivation. If we make food choices based on caloric information, rather than on what we crave, we’ll begin to feel deprived, just as dieters do. Food choices based on food cravings (“I feel like a cheese sandwich for lunch” vs. “I should have a salad”), as part of a balanced overall diet, are more likely to be associated with healthier attitudes toward food and reduced incidence of overeating.

Does Your Facebook Make You Fat?

An article in The Washington Post reports that Facebook users who come across dieting ads may actually be setting themselves up. Advertisers are privy to the type of person you are based on your profile and the content of messages you send. A lot of diet talk? Muffin top, you are.

What type of ads appear on your Facebook (or other favorite web page) home? Does this relate to what you reveal?