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NEDAW: Eating disorders’ forgotten victims

23rd February 2010

NEDAW: Eating disorders’ forgotten victims

by Rachel

This month is Black History Month and this week is National Eating Disorders Awareness Week, and Stephanie Armstrong addresses both in an interview on “Saturday Mornings with Joy Keys,” an interactive, live Internet talk-radio show that focuses on “providing people with tools to enrich and advance their lives mentally, physically, monetarily and emotionally.”  Stephanie  is the author of the new memoir Not All Black Girls Know How to Eat: A Story of Bulimia, in which the now 40-something, recovered, married mother of one daughter and two stepdaughters documents her descent into bulimia in her early 20s and describes her struggles as a black woman with a disorder consistently portrayed as a white woman’s disease.  The Brooklyn native also examines the “bootylicous” black woman stereotype and why the black community’s “code of silence” often leaves black women with eating disorders suffering in silence.  The work is being hailed as the first book by and among black women about eating disorders.  You may remember that Stephanie also answered the-F-word’s questions a few months ago.

Guests included Stephanie and Laurie Vanderboom, program director for the National Eating Disorders Association, which sponsors and coordinates National Eating Disorders Awareness Week.  A few interview highlights

Joy: What do you (NEDA) see when you have these programs?  Do you see a lot of African American women coming to the programs?

Laurie: We’re just beginning to and we’re just beginning to reach out.  There’s so much shame involved in an eating disorder that people hesitate to step up.  Stephanie, wouldn’t you agree that no matter what your racial make-up…

Stephanie: Absolutely, but especially coming from a culture that doesn’t support therapy, that doesn’t support getting outside help, and risking falling outside of the strong black woman archetype that we’re raised believing and have to become.  It’s hard to disassociate yourself with that image to get the help you need.

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Stephanie: One of the things I always talk about, especially in the black community, is that we don’t have an awareness of what exactly bulimia is.  It’s like you go to someone’s house and they’re drinking that dieter’s tea.  That’s bulimia.  Laxative abuse is bulimia.  Diuretic abuse is bulimia.  Compulsive exercising is bulimia.  It’s like we think it’s just throwing up, but it’s not just throwing up.

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Joy: I was talking with a professor of mine and he mentioned that psychologists don’t diagnose African American women properly with eating disorders, because they’re not used to seeing a African American woman coming to their office with this issue. Stephanie, do you feel that that’s the case?

Stephanie: Absolutely. Absolutely. I am constantly talking to women — some who are therapists, some who are young — who are constantly misdiagnosed. I’ve had doctors say, ‘Oh, you don’t have an eating disorder. African Americans don’t have eating disorders.’ I had a young woman call me yesterday – she goes to Clark Atlanta College and she’s at the American University in DC working on an exchange and she’s doing a paper in journalism and decided to do a paper on blacks and eating disorders because her aunt was bulimic and died from it. She calls me up and she said her teacher said, ‘Well, the problem is that there aren’t really that many black women with eating disorders, so that’s going to be a hard paper to do.’ It’s that overall belief that we don’t exist. (she briefly cites a rundown of research showing the prevalence of eating disorders among black women and girls, including this study) …the research is seeping in, but it’s still not getting the attention.

And it’s not just black women with eating disorders who are thought to be virtually non-existent.  Running Tiptoe recently posted a review of a recent “Intervention” episode featuring an Hispanic woman with an exercise addiction and a history of bulimia.  In her review, she offered this link to this 2006 study of “eating disturbances among Hispanic and native American youth,” in which it was found a much more significant pattern of disordered eating behaviors than previously thought.  There are more stats and studies on Hispanic women and eating disorders listed in this 2003 news report.*

Despite all the evidence to the contrary, eating disorders continue to persist in public opinion as a disease young, white girls from middle-class and wealthy backgrounds develop.  But eating disorders are the great equalizers: food is one of the few legal “drugs” out there; everyone needs it to survive;  and in industrialized nations, at least, is widely available and relatively cheap.  That, combined with the constant affirmations of weight loss as morally good and idolization of thinness saturating virtually every facet of our lives, and it’s no wonder that  those with emotional issues and unfulfilled needs might turn to food and the body to express a pain they cannot put into words.

Black girls and women with eating disorders.  Hispanic girls and women with eating disorders.  Adult women with eating disorders.  Boys and men with eating disorders.  Orthodox Jewish girls and women with eating disorders.  Poor girls and women with eating disorders.  We. All. Exist.

* For more information on eating disorders amongst non-white populations, see here.

posted in Anorexia, Binge Eating Disorder, Bulimia, Class & Poverty, ED-NOS, Eating Disorders, Gender & Sexuality, Interviews, Mental Health, New Research, Purging Disorder, Race Issues, Rachel, Recovery | 5 Comments

10th February 2010

Big changes proposed in eating disorder diagnoses

by Rachel

Given the blog’s focus, it’s not often that I have good news to report, so I tend to get a little giddy when the cosmos align in our collective favor. I blogged back in December, 2008 about proposed changes under consideration by the American Psychiatric Association to the fifth edition of its Diagnostic and Statistical Manual of Mental Disorders (DSM).  Considered the psychiatric bible of the field, the DSM is used by doctors to make a diagnosis and provides insurance companies with diagnostic codes without which the insurers will not reimburse patients’ claims for treatment. Among the conditions up for debate included making binge eating disorder (BED) an independent diagnosis (BED is currently lumped into the vague catch-all category of ED-NOS, which encompasses those who don’t meet one or more of the criteria for anorexia or bulimia).

You’d think that a condition estimated to eclipse both anorexia and bulimia combined would be a no-brainer for inclusion, right?  You’d think wrong.  Some mental health professionals actually protested classifying BED as a disorder, suggesting it to be a “normal behavior.”  Luckily for those who suffer from decidedly abnormal binge eating behaviors, the duh truck must have finally arrived at the APA, because when they released a draft of its recommendations today, it included recognizing BED as an official independent diagnosis — read the recommended criteria for diagnosis here.  This is awesome news, for in addition to psychotherapy, there are medications that have been shown to help people with binge eating disorder (Topamax and Wellbutrin, for example). If binge eating disorder were included in the manual as a legitimate eating disorder, those people who struggle with it might have an easier time getting insurers to cover the treatment and medication they so desperately need.

The recommendation of BED as an independent diagnosis is certainly the biggest change for eating disorders in the DSM, but there are other proposals under consideration that I think are pretty fabulous, too.

Purging Disorder

The work group is considering whether it may be useful and appropriate to describe other eating problems (such as purging disorder–recurrent purging in the absence of binge eating, and night eating syndrome) as conditions that may be the focus of clinical attention. Measures of severity would be required, and these conditions might be listed in an Appendix of DSM-5. If these recommendations are accepted, the examples in Eating Disorder Not Otherwise Specified will be changed accordingly.

As someone who suffered from what would be considered purging disorder with anorexic tendencies and was misdiagnosed with bulimia, I’m excited to see this relatively newly-popularized condition being entertained by the panel.  Pamela Keel, an associate professor of psychology in the UI College of Liberal Arts and Sciences, has made great inroads in research indicating purging disorder to be a significant problem in women that is distinct from bulimia.

Anorexia

Many eating disorder activists are critical of the phrasing in the criteria for anorexia of a “refusal to maintain body weight at or above a minimally normal weight for age and height.”  Refusal here, being the key word as myself and others argue that it’s not so much a refusal as it is an inability.  For more on this, read Harriet Brown’s critique of the semantics.  In its draft, the APA recommended clarifying the criterion to focus instead on behaviors, acknowledging that the word “refusal” implies intention and is “possibly pejorative and difficult to assess.”  The panel also recommended deleting the criterion of amenorrhea, thus opening up the diagnosis to a broader range of sufferers, including a growing number of men reporting anorexic behaviors.

In DSM-IV, amenorrhea is required. However, individuals have been clearly described who exhibit all other symptoms and signs of Anorexia Nervosa but who report at least some menstrual activity. In addition, this criterion cannot be applied to pre-menarchal females, to females taking oral contraceptives, to post-menopausal females, or to males. However, there are some data that women who endorse amenorrhea have poorer bone health than do women who fail to meet this criterion.  Deletion of this criterion is recommended.

Bulimia

The current DSM-IV requires episodes of binge eating and inappropriate compensatory behaviors both occur on average twice a week for three months.  The panel cited a literature review that found that the clinical characteristics of individuals reporting a lower frequency of once/week were similar to those meeting the current criterion, so they recommended that the required minimum frequency be reduced to once/week over the last three months.  The bulimia diagnosis also currently includes two subtypes: purging and non-purging.  People with non-purging bulimia often try to purge calories via exercise or fasting, but do not use enemas, self-induced vomiting, laxatives, etc..  The panel found that non-purgers more  closely resembled people with BED, and so they recommended deleting this subtype altogether.

Obesity

Despite reports from the Boston Globe that the APA was considering classifying obesity a mental illness, I see nothing in the draft indicating that it would be included.  The sheer ridiculousness of such a proposal simply blows my mind and at first I thought the Globe perhaps erroneously conflated obesity with binge eating disorder, since those with BED tend to be overwhelmingly overweight or obese, but it appears as if the idea was at least introduced.  A study released last summer examined the evidence for making obesity a mental disorder and found it significantly lacking, acknowledging only “evidence that obesity is related to mental disorder and many of the medications used to treat psychiatric illness.”  Considering that the latter evidence has been around since the 1990s, the study basically only confirmed the obvious.

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Before we pop the cork on the champagne, keep in mind that this is only a draft, and is subject to change and that’s where you come in.  In a new twist for the APA, the organization has posted the draft online and is seeking feedback via the Internet from both psychiatrists and the general public about whether the changes will be helpful before finalizing them.  The draft manual, posted at www.DSM5.org, is up for public debate through April.  The final version is expected to be released in 2013.

posted in Anorexia, Binge Eating Disorder, Bulimia, ED-NOS, Eating Disorders, Mental Health, New Research, Purging Disorder, Rachel | 16 Comments

2nd February 2010

What We Missed

by Rachel

A new study of 1,000 American girls between the ages of 13-17 by the Girl Scouts finds that 9 out of 10 girls say they feel pressure from the media and/or fashion industry to be skinny.  More than 80 percent of the girls polled said they’d rather see natural photos of models than digitally enhanced or altered photos.

Specialists calculate life expectancy for people with anorexia to be 25 years shorter than average.  Patients who recover however, may expect full lifespans.

A Chicago mom and grandmother shares her story of finally overcoming anorexia after 25 years of battling the disorder.

Remember the mental health parity law that passed in 2008? The The U.S. Departments of Health and Human Services, Labor and the Treasury jointly issued new rules this week governing the law.

The Website Realself.com tracked cosmetic surgery trends by region and even city with some surprising results.

New “groundbreaking” study shows abnormal brain function in people with body dysmorphic disorder.

Eve Ensler: Girl power can save the world.

The New York Times reviews Michael Pollan’s new book, “Food Rules: An Eater’s Manual.”

posted in Anorexia, Body Image, Book Reviews, Eating Disorders, Fashion, Food Culture, Mental Health, New Research, Pop Culture, Rachel, Recovery | 8 Comments

6th January 2010

Young adults swallow weight loss spam claims

by Rachel

Spam.  It’s the bane of anyone with an email address.  We all loathe and despise it, but does anyone actually buy the often ridiculous and over-the-top products being shilled?  It  turns out that when it comes to weight loss spam, young adults who think they’re fat swallow it en masse.

Researchers Joshua Fogel of Brooklyn College and Sam Shlivko of New York Law School conducted a survey of 200 New York college students about their experiences with spam email for weight loss products (published here in the January edition of Southern Medical Journal).  Participants were asked, “Do you believe that you have weight problems?”  One-third answered that they did and responses were then compared along those lines.  Keep in mind that the study only asked for a yes-or-no response as to whether someone believed they had a weight problem, meaning that this group could have realistically included both students who are certifiably fat or those who just think themselves the size of a landbarge.  Of those students who reported to have weight problems:

  • 85 percent said they had received weight loss spam over the past year, compared to 73 percent of those without weight problems
  • 42 percent opened and read spam email advertising weight loss products versus just 18 percent of those without weight problems
  • 19 percent said they had bought a weight loss product from spam — as did five percent (!) of those without weight problems.

Researchers also measured participants’ psychological stress according to the Perceived Stress Scale and the Rosenburg Self-Esteem Scale.  Not surprisingly, students who reported weight problems had lower self-esteem and higher perceived stress, which, in part, influenced their proclivity to open, read and purchase weight loss spam.  In all, after adjusting for other factors, students with reported weight problems were about three times more likely to receive and open weight loss spam and to buy the products pitched.

So, what’s the big deal, some might ask.  We’re constantly bombarded with the mantra that “diets don’t work” and the only thing these students have to lose is their money, right?  Wrong.  As Fogel noted in his report, there is no quality control for products advertising in spam emails.  The current law on dietary supplements gives the FDA jurisdiction only after the products go on the market.  And instead of reviewing the supplements and approving them for sale, as the agency does with drugs, the FDA is limited to spot-checking manufacturers and distributors and testing products already on store shelves.  In February, the agency issued warnings for 70 weight loss supplements found to contain unlisted and potentially dangerous ingredients — see the complete list here.  And this list, most of which are imported from China, represents only a teensy tiny fraction of the dangerous and often ineffective diet pills available in what is a $1.7 billion dollar a year market.  The FDA itself admits that it simply does not have the resources to identify what may be hundreds of other drug-contaminated weight-loss supplements for sale. Some spam emails even advertise and sell prescription medications without requiring proof of a valid prescription.  And not addressed in the report is the more alarming consideration that responding to weight loss spam only reveals what may be a larger and more shadowy pattern of disordered eating and fad or yo-yo dieting, all of which take their toll on health and may even ironically lead to even greater weight gain.

Products purchased via weight loss spam can also take a blow to one’s pocketbook and even credit ratings.  Since posting my expose on one acai berry diet scam more than a year ago,  responses — 139 as of this posting — continue to trickle in from duped buyers who report being scammed charged hundreds of dollars in unauthorized expenses for “free” trial offers and when they call to cancel, either find that the customer service number has been disconnected or are put on hold for an ungodly amount of time by agents who often refuse to refund their money and sometimes even to cancel their orders altogether.

Researchers note that the findings indicate that young adults with weight problems are “apparently not seeking or not satisfied with evidence-based treatments available from physicians… or other health care providers.”  And therein lies the problem, for as physicians, scientists, researchers and specialists admit, there is no proven way to make — and keep — fat people thin.  The National Institutes of Health and other studies show that, on average, 95-98 percent of people who lose weight gain it back within five years. Only 2-5 percent of dieters succeed in keeping their weight off while 90 percent of those gain back more weight than they lost.  Even those who undergo weight loss surgery mostly become less fat, with weight regain rates both high and common.

Trust me.  If some virtuoso discovers that enchanted unicorn horn dust will magically whittle our waistlines, he/she would be hailed as a global fat-fighting hero, invited to the White House for a few cold ones (all lite, of course), awarded the Nobel Prize amidst international fanfare and be secretly masturbated to by MeMe Roth.  Insurance companies everywhere would cover these miracle pills in full without reserve; they’d be added to the water supply with fluoride and the government would pass them out like candy.  But as the old adage cautions us, if it’s too good to be true — and it’s peddled by spam-mongers — it probably is.  My advice?  Invest in a good spam filter and save yourself some time, money and sanity.

posted in Body Politic, Diets, Drugs & Medications, Health, Nutrition & Fitness, New Research, Rachel | 8 Comments

14th December 2009

Disturbing bariatric surgery market forecasts in 2010

by Rachel

This is a post I’ve had simmering on the back burner now for a few months and am just now getting around to posting…

My older brother has always been a husky guy. He’s lost and regained the same 50-60 pounds or so several times in his adult life. Some months back, he went to see a new doctor for a check-up, which surprised me given Jim’s phobia of all things medical (he spent several weeks in ICU as a teen for severe asthma and pneumonia and has been doctor-wary since). Other than slightly elevated cholesterol levels, Jim checked out A-OK health-wise. Then the doctor decided to give him “the talk.”

Yeah, fat folk everywhere know what I’m talking about.

Jim said that the doctor seemed very nervous and after some fumbling, finally told him that his BMI was XX and asked if Jim knew what that meant. “Yeah,” said Jim with a laugh, “It means I’m fat.” If my brother is self-conscious about his weight, he doesn’t show it. He’s one of those kinds of people who will tell you that he’s a big fat cliche (sedentary, supersized fast food diet, regular soda drinker) and doesn’t apologize for it.  Jim’s thick-skinned attitude seemed to break the ice and the doctor then discussed his options, or rather thereof. “Have you ever considered weight-loss surgery?” he asked.  “You’d be a good candidate for…”  Jim stopped the good doctor mid-sentence. “I’ve lost weight before by eating healthier and exercising,” said Jim. “Weight-loss surgery isn’t even a consideration for me.”

I find it disturbing that the doctor’s first recommendation was not for Jim to improve his diet or exercise more, but rather to go under knife and rewire a perfectly functioning digestive system. Of course,the best way to a patient’s wallet is through his stomach — simply eating healthier and moving more won’t pay for the good doctor’s Lexus.

What was once considered to be a last, desperate option reserved only for those with life threatening weight-related health issues has now become so ubiquitous that at least one weight-loss surgical procedure (lap-band) is now considered to be an elective, cosmetic surgery and is being marketed by some facilities to people with just 30-40 extra unwanted pounds.  The National Institutes of Health states that bariatric surgery should be reserved for those with a BMI of 40 or more or those with a BMI of 35 and a weight-related co-morbidity, but “co-morbidity” here is a vague term that can be — and is — used to describe any condition from headaches to depression in order to circumvent the strict requirements insurance companies set for qualified candidates.  There were 220,000 bariatric surgeries performed in 2008 (in the U.S.), up from 205,000 performed in 2007.   Despite the economic recession, one healthcare market research firm estimates there to have been 350,000 procedures performed worldwide in 2009, which translates into sales of $517 million for surgical devices used in bariatric surgery, or a 21.6 percent increase over 2008 sales.  And the profiteers are hard at work devising new markets and demographics to drain. Health News Digest has a rundown of some of the disturbing bariatric surgery trends we can expect to see in 2010:

  • Grand Opening: New Surgical Weight Loss Program for Teens — As the list of benefits of weight loss surgery in teens increases, we will see more surgical weight loss programs for teens popping up at hospitals across the map.
  • Surgeons will be offering revision surgeries such as the transoral ROSE to people who have previously had weight loss surgery but have gained the weight back – a growing population both literally and figuratively.
  • Weight Loss Surgery Not Just for the Obese — As studies highlight the curative powers of bariatric surgery, there will be a push to offer it to people with even lower body mass indexes (BMI). …if people who are just moderately obese also have diabetes, they too should be considered candidates. [Even the government isn't convinced that WLS for moderately overweight people with diabetes is beneficial.]
  • Hourglass Figure Possible After Massive Weight Loss — More and more people are undergoing bariatric surgery to lose weight, only to be left with hanging fat and flab in visible areas. As plastic surgeons put on their thinking caps to better address these issues, expect to hear about many new procedures, including the corset trunkplasty. [Surgeons' fees average $1,400 to $1,800 for gastric bypass, but some bariatric surgeons also offer offer tummy tucks and other cosmetic procedures to remove excess skin, charging up to $14,000.]

No mention is made of a trend amongst doctors in recommending a major surgical procedure that carries a litany of serious medical risks, many longterm and including death, (up to five percent of WLS patients die in the first year, according to one doctor) as a fat patient’s first and only choice in healthy weight management, but it is, no doubt, a phenomenon not only occurring in just my brother’s doctor’s office.  Patient beware.

posted in Fat Bias, Health, Nutrition & Fitness, New Research, Rachel | 12 Comments

28th September 2009

Can’t lose weight? Maybe it’s because you like yourself too much

by Rachel

I went off and on my antidepressant medication several times during my eating disorder.  If one were to eavesdrop on the chattering debate between the angel and devil on my shoulders, this is what you might have overheard:

Angel: You need to take your medication because you can’t function without it.  You alienate yourself from your friends and family, your work suffers, you lose interest in everything and you get angry, depressed and suicidal.

Devil: Oh, sure, but just think of your fat ass.  You know you can’t lose weight unless you hate yourself, and the pills are probably causing you to gain weight.  Would you rather be depressed or fat?   Take your pick.

Now a new study confirms what so many of us know oh, too well: a dose of self-loathing is an important part of weight-loss dieting.

Researchers in Japan conducted psychological profiles of 101fat men and women undergoing a six-month “holistic” weight-loss program (the six-month study originally included 147 people, but 46 dropped out).  Participants were screened so that anyone who is fat because of endocrine or psychiatric disorders were excluded.  Among other findings, the study found that people with a happy-go-lucky outlook at the start of therapy were less likely to “succeed” (a.k.a. lose weight) than people who were more depressed, cautious and self-critical.  They termed the former as a “free child” or FC ego and the latter as the “Adult” or A ego.

The researchers concluded, in essence, that while FC ego folks were able to control negative emotions, act independently and assertively and look at the glass as half-full — which they describe as all positive aspects — this outlook also led them to be less caring of disease and more likely to give into instinctual or impulsive behaviors, which, researchers assumed, is why they were fat.  In other words, because the FC people were not as susceptible to the often commercially-funded and greatly-exaggerated OMG FAT KILLS hysteria and fear-mongering, they liked themselves more and were less willing to practice willful or unnatural self-deprivation.  Writing in the journal BioPsychoSocial Medicine, the researchers noted that: “…other studies have reported that some negative emotion has a positive effect on the control of weight and blood sugar levels. This study supports these previous findings regarding the relationship between optimism and carelessness in terms of disease prevention behavior modification.”

The scientists therefore sought to increase these critical and self-regulating A ego type characteristics in those with an FC ego in order to promote weight-loss.  The results certainly backed up the hypothesis: Those FC folks who were eventually sold on the anti-obesity mania were more likely to lose weight.  But by its very nature, the study may have been a self-fulfilling prophecy.  It’s well known that robbing the body of nutrients and energy can be a causal factor in depression and mood disorders, which, as the researchers suggest, may be necessary for weight-loss. Read the study’s provisional PDF here or check out this brief story on it by The Guardian.

That being said, I don’t think that everyone who has lost weight and sustained it for any length of time hates themselves necessarily.  While my eating disorder certainly required a great degree of self-loathing to flourish and thrive, I’ve been able to maintain a significant weight-loss healthily for six-plus years now precisely because I have come to a place where I accept and love myself.  There were times during my disorder when I would literally punish myself for breaking a 10-day fast or missing a workout by binge eating to the point where I was sure I would gain 10-pounds overnight.  “You want to be fat?” berated that voice in my head.  “Fine.  I’ll make you fat and then you see how you like it.“  Other times I’d feel so bad about myself that I self-medicated with chocolate or fast food without caring what it was doing to my body and health.

Now that my self-esteem has improved and I care about both my mental and physical health, I eat healthy and am physically active.  The key difference now however, is that I do these things without the expectation that weight-loss will naturally result.  I eat a healthy vegetarian diet because it keeps my mind keen and alert, meets my body’s energy and nutritional needs and falls in line with my spiritual and ethical beliefs; I participate in physical activities I enjoy because it helps with stress and depression and keeps my body limber and strong.  I should also note that while finally enjoying a sane relationship with food has helped me maintain a weight-loss, it hasn’t resulted in weight-loss itself — I’m simply less fat than I was before.  What my new relationship with food has given me (in addition to good mental health) is near perfect blood pressure, cholesterol, glucose, and other numbers indicative of good health.

How about you?  Do you need to hate yourself in order to lose weight?  In what ways is your sense of body image and weight intertwined?  Share your experiences below.

posted in Body Image, Diets, Eating Disorders, Mental Health, New Research, Personal, Rachel | 25 Comments

4th September 2009

The forbidden (sugar-coated, chocolate-covered, high-fructose-corn-syrup-laden) fruit

by Rachel

A few months ago the New York Times published a story on the legions of parents who are becoming hyper-vigilant about their children’s consumption of sugar, processed foods and trans fats.  MSNBC has a similar, albeit less in-depth, story out this week on the increasing numbers of food cop parents.

Driven by concern about childhood obesity or other food anxieties, more nutrition-focused parents are turning into food cops, monitoring every morsel their children eat. They not only refuse to allow sugary snacks in their own homes but also fight to ban fattening foods from school lunches or childhood parties. For them, every cupcake becomes a potential future health crisis.

MSNBC paints it as kind of an epidemic of PTO groups being overrun by rabid MeMe Roth clones, but it’s hard to know just how widespread the issue really is.  Still, it’s enough of an issue for groups to obtain funding for studies on the often counterproductive consequences of patrolling your kid’s lunchbox.  The story references one recent study from the Center for Childhood Obesity Research at Pennsylvania State University, which tracked 200 girls for 10 years from age 5.  It found the highest weight gain among girls who considered their parents most restrictive about eating certain foods.

Anyone who has ever dieted or struggled with disordered eating knows all too well that the food you categorize as public enemy number one is usually the same food that you obsess about until you usually overindulge.  The same goes for kids.  As nutritionist Andrea Giancoli explains, banning “bad” foods usually only inflames kids’ desires for the forbidden (sugar-coated, chocolate-covered, high-fructose-corn-syrup-laden) fruit.

“They’ll go to a friend’s house and pig out on junk,” she says.  Giancoli also objects to making little Johnny eat all his carrots and peas before he can have a cookie. “What research finds,” she says, “is that the reward food becomes more desirable in the child’s mind, and certain ‘good foods’ become increasingly despised.”

For all the effusive weight-loss gushing usually seen in MSNBC health stories, the tips they provide at the end of the story are actually good ones: Banish the clean-plate club; educate children about nutrition; and perhaps most importantly, be a role model.

How about you?  What kinds of food habits did you learn from your parents?  If you’re a parent, what kinds of messages are you sending your kids about food?

posted in Family Issues, Fat Bias, Food Culture, Food News, Health, Nutrition & Fitness, New Research | 38 Comments

6th August 2009

New Study: Another reason not to have fat friends

by Rachel

As if fat kids need any more reason to be turned into social pariahs, a new study says, in short, that friendships among fat kids make fat kids even fatter.

The study, published in the August issue of the American Journal of Clinical Nutrition, involved 23 overweight and 42 normal weight* children between the ages of 9 and 15.  The children were paired for 45 minutes in a room first with a friend and then with someone of a similar age they did not know.  The room was equipped with games, puzzles and individual bowls of low-calorie carrots and grapes and high-calorie potato chips and cookies.  The kids were told to eat as much or as little as they wanted, but were asked to eat from their own bowls that were later weighed to determine consumption.  The results showed that regardless of weight, friends paired together ate more than when paired with someone they didn’t know and were more likely to eat similar amounts.  The study also found that overweight children who were paired with an overweight peer, whether friend or stranger, ate more than the overweight participants who were paired with a normal weight youth.  Keep in mind that researchers predicted their results even while recruiting study candidates — their intentions were very transparent.  The study, filed under the category of “obesity and eating disorders,” is now being used in the war on fat children.

“Overweight children are more likely to find food more reinforcing than non-overweight youth,” said Sarah Salvy, Ph.D, assistant professor in the Division of Behavioral Medicine, Department of Pediatrics, University of Buffalo School of Medicine and Biomedical Sciences. “Being in the company of overweight peers may give them the permission to eat more or may decrease their inhibitions, increasing what are seen as the norms of appropriate eating, or how much one should eat.”

“Given the impact of friends on eating behavior, it appears that if we hope to change the growing obesity epidemic among children, friends and family need to be involved,” said Salvy. “If the environment in which children live doesn’t change — if family meals remain high calorie and overeating is the norm — any progress children may make in their eating behavior won’t last.”

The first problem of this study is that it assumes the amount of food eaten by normal weight children to be the norm, thus If an overweight child eats more than a thin peer, it’s by proxy viewed to be compulsive overeating or pathological in behavior even though overweight children require more energy per increased body weight.  The second problem of the study is that the simple fact of choosing chips over carrots and/or eating more snacks than a normal weight peer is not, in itself, indicative of an eating disorder, as the study’s categorization suggests.  Eating disorders are psychological illnesses — often organic in nature — that at their heart, are very little about food and weight and more about emotional instability and sometimes other psychiatric conditions.  This is why of the three recognized eating disorders — anorexia nervosa, bulimia nervosa and ED-NOS — weight is a consideration only in the diagnosis of anorexia and even that criterion is being actively debated.

The study also assumes that because fat kids eat more around other fat kids, whether they be friends or strangers, that this ubiquitous “social network” among them is somehow to blame for why they are fat.  So long as we’re assuming, I will therefore assume that Salvy and her team of undergraduate researchers have never struggled with weight because if they had, they would understand the acute social stigma attached to eating in public, especially in the company of a thin peer, that is commonly experienced by fat people and especially by fat girls and women.  Remember the smallest salad study?  In her study of social dining habits, psychology professor Patricia Pliner found that people tend to match their intake to that of whomever they’re eating with, and women in particular tend to eat the least when around other women because small eaters were perceived to be more feminine, more concerned about appearance, and better-looking than the larger eaters.  The only exception she found was when people were dining with close friends and family members around whom they felt comfortable and non-judged.

Considering the sheer amount of weight stigma and the increasing legislative and local attention on childhood obesity, the fact that the overweight children ate more around other fat kids, strangers or not, may be simply be because that same ubiquitous “social network” allowed them the freedom to eat an appropriate amount for them whereas they showed restraint around thinner peers.  For the same reason that normal weight and overweight children ate the same amount when paired with their respective normal weight and overweight friends, these fat kids may have felt comfortable and non-judged around unknown fat kids because their shared fatness created between them a common, recognizable bond as the fat other.  As Deb Burgard, an eating disorders specialist who alerted me to the study on the ASDAH newslist, points out: “Perhaps the differences you are seeing are between a relatively normal intake among friends and heavier kids who are relieved, for the moment, not to have to do ‘impression management’ with their peer…”

Imagine had the study assumed the amounts eaten by overweight children when paired with other overweight children to be the norm instead of vice versa.  Instead of concluding that eating with overweight children “decreased the inhibitions” of overweight participants, we might instead be asking why normal weight children showed an increase in restraint while in the presence of unknown normal weight children.  Because thin kids don’t escape the baggage of a weight-obsessed culture, either; they just react in different ways to it. Sadly, this doesn’t seem to be a consideration for researchers.  Salvy and her team are now recruiting candidates for a similar study but one also involving parents.  Here’s one of their hypotheses:

The investigators hypothesize that overweight children and adolescents will select more unhealthy food items and eat more in the presence of an overweight friend than when eating with a lean friend; whereas lean participants eating with an overweight friend will eat a similar amount of food than lean youth eating with a lean friend.

Keeping in mind the sheer popularity of foods that taste good (junk food) over that of healthier foods often perceived to be less tasty among fat and thin teens, let’s reconsider these predictions: Overweight kids paired with overweight kids eat the same amount.  Lean kids paired with other lean kids eat lesser, but similar amounts as each other.  Overweight kids eating with a lean peer will eat less but the same amount as their thin peer, who eats more than when paired with a lean peer.  It would appear that the only time restraint isn’t shown is when overweight kids are paired together.  And yet given the the curious assumption of the study’s classification in relationship to eating disorders, the concern seems to be not that lean kids show a marked restraint in eating what may be anorexic levels of intake around other lean kids, but that fat kids consciously or unconsciously encourage lean kids to eat unhealthy foods and more of them.  Sure, overeating can be a signal flag for an eating disorder, but it also depends on how and what you designate as appropriate intake levels, a measurement that seems to be askew here given the clear anti-obesity research agendas.  It’s all a matter of perspective and it’s clear which perspective is being represented here and which isn’t.

I can see it now: “No, Suzy, you can’t hang around with Jenny.  She’s fat and you’re fat enough as it is!”  Speaking from personal experience, it’s hard enough for a fat kid to find and make friends.  Must we really make it all the more difficult for them?

* I normally dislike using the terms “overweight” (over whose weight?) and “normal” weight, but I will in this case since these are the categories used in the study.

posted in Body Image, Fat Bias, New Research | 19 Comments

4th August 2009

Hard to swallow

by Rachel

Ever since I found out a few months ago that I was severely deficient in vitamin D, it seems that it’s there’s been a barrage of health articles on the subject.  But this Washington Post article (via MSNBC) is the first to link vitamin D with not only diabetes, but also the big bad obesity epidemic.

The lede reports the alarmist find that: “Millions of U.S. children have disturbingly low Vitamin D levels, possibly increasing their risk for bone problems, heart disease, diabetes and other ailments…”  Never minding the fact that my doctor told me that most people are deficient in vitamin D, the researchers of two new studies on the subject go on to make value-based judgments on why this is so:

Low Vitamin D levels are especially common among girls, adolescents and people with darker skin, according to the analysis of a nationally representative sample of more than 6,000 children. For example, 59 percent of African American teenage girls were Vitamin D deficient, [Michal L.] Melamed’s study found.

The researchers and others blamed the low levels on a combination of factors, including children spending more time watching television and playing video games instead of going outside, covering up and using sunscreen when they do go outdoors, and drinking more soda and other beverages instead of consuming milk and other foods fortified with Vitamin D.

“This appears to be another result of our unhealthy lifestyles, including a sedentary society that doesn’t go out in the sun much,” Melamed said.

I’m not debating that too little vitamin D is harmful for children — I’m a big proponent of vitamin D after being prescribed it myself and feeling a surge of energy return just days after taking my first supplement.   Instead, what I question are the assumptions the researchers come to as to why children today are deficient.  Keep in mind that an accurate measure of vitamin D levels appeared only 15 years ago and that it has taken 5-10 years for it to reach widespread use.  The tests are so new, in fact, that doctors are still debating the government’s official guidelines for recommended daily intake.  Before this, the only indicator of a vitamin D deficiency was rickets, a deformative softening of the bones condition that is usually brought on by a severe case of vitamin D and also calcium deficiencies usually as the result of famine or starvation.  Most people who are deficient in vitamin D don’t even know it as the symptoms can be so vague and are often attributable to other conditions/factors.  Children today may be no more deficient than their peers of yesteryears; it may be that we are only now able to accurately measure these widespread deficiencies.  Let’s dissect these so-called “unhealthy lifestyles” researchers say are now to blame for childhood vitamin D deficiency:

1. Sedentary lives leading to insufficient sunlight exposure:  Vitamin D is often called the “sun vitamin” because our bodies produce it upon exposure to the sun, but sunlight is unreliable and several factors influence its ability to induce vitamin D production: angle of the sun, latitude in which one lives, skin pigmentation and use of skin-care products containing SPF.  A MedPageToday article on the two studies notes that researchers lacked information on the children’s exposure to sunlight, so no causality can really be established here.

2. Sunscreen use: This is an “unhealthy lifestyle” choice?  Really?  What’s unhealthier?  The leading type of cancer –skin cancer– or a vitamin D deficiency?

3.  Increased soda consumption/Decreased milk consumption: The fact that low vitamin D levels are especially common amongst people of color isn’t surprising considering that 95 percent of black people and the great majorities of other people of color are lactose-intolerant –a genetic fact that is never mentioned in either article (or in milk-drinking campaigns and government guidelines).  Many people of color lack a digestive enzyme needed to digest the sugars in milk and while this intolerance usually doesn’t manifest itself until adolescence or adulthood, it can still pose problems for children of color.  The fact that the still largely milk-white medical community still recommends fortified milk consumption for healthy vitamin D levels demonstrates a classic case of lingering racial discrimination in health care.  Research has shown that an inability to digest milk is not a genetic mutation, but rather a genetic norm — the gene for lactase normally switches off as children are weaned and only a small percentage of humans (namely, white folks) in whom the gene is not turned off are able to drink milk into adulthood.  This is why some in the medical community have begun to regard us milk-drinking anomalies as “lactose persistent” instead of labeling those who can’t digest milk as “lactose-intolerant.”

Apart from fortified milk, foods naturally rich in vitamin D are scarce –seafood tops the list, along with some cheeses, yogurts, cereals and juices.  Since food is not a reliable source of vitamin D, doctors usually recommend taking supplements, which are available over-the-counter in low doses and by prescription for high doses like mine.  The supplements aren’t overly-expensive, but can be pricey for families on a budget when you consider that it first requires a doctor’s visit to determine if a deficiency exists and what dosages are needed, along with seasonal follow-up appointments to determine future dosages.  Since people of color tend to be disproportionately poorer than white people, it stands to reason that this may not be a lifestyle “choice” as it is a socio-economic fact of life.

Even more interesting are the medical findings of the studies, which are listed in more detail on the MedPageToday article:

Children with low levels of 25-hydroxyvitamin D were more likely to be overweight and/or obese (P for trend <0.001 for both), but even after the researchers adjusted for age, gender, race/ethnicity, body mass index, socioeconomic status, and physical activity, they found that low vitamin D was often accompanied by high systolic blood pressure, high blood sugar, and metabolic syndrome.

These conditions, which are all risk factors for cardiovascular disease, were present regardless of whether the children were overweight or not, the researchers said.

Missing in both articles is the mention that a chief symptom of metabolic syndrome is weight gain.  This may be because many in the medical community believe weight gain not to be a symptom of metabolic syndrome, but rather a cause of it.  WebMD’s page on metabolic syndrome states matter-of-factly: “Metabolic syndrome is caused by an unhealthy lifestyle that includes eating too many calories, being inactive, and gaining weight, particularly around your waist.”  Since the studies are the first of their kind, more observation is needed, but it stands to reason that if so many children are deficient in vitamin D, then just as many, if not more, adults are also deficient.  And if a vitamin D deficiency has been linked to metabolic syndrome and high blood sugar independent of weight, then perhaps not all people with the condition are just lazy, Twinkie-munching couch potatoes with a spare tire or two.

posted in Class & Poverty, Fat Acceptance, Fat Bias, Health, Nutrition & Fitness, Mind & Body, New Research, Race Issues | 24 Comments

24th July 2009

Smell-o-vision your way thin?

by Rachel

Michelle over at the blog Fat Nutritionist today posted this gem of an it-would-be-hilarious-if-it-weren’t-real diet pop culture infomercial from the 1990s.

Ridiculous? For sure, but the crazier thing is that aromatherapy diet products are still being produced and marketed. I posted a link on the site’s Twitter page a couple weeks ago to this New York Times piece on new trends in diet aromatherapy. Diet aromatherapy products currently come in two flavors: when sprinkled on food, one variety of “crystal” granules on the market since last year heightens the scent and flavor of food with the assumption that it will suppress hunger hormones; and another, a nasal spray still in development, works by blocking smell with the idea being that, as in the infomercial above, you’ll naturally lose your appetite. “The hypothesis is that if we can alter your sense of smell we can make food less palatable, because the hedonic effect — that is, the pleasurable effect you get from eating chocolate — won’t be there,” said Christopher Adams, a molecular biologist and the founder of a company that produces the latter spray.

Find it hard to swallow? The idea certainly makes biologic sense when you consider that 80 to 90 percent of what we perceive as taste is actually smell. It’s the very reason why people on Fear Factor hold their nose when downing worms and cockroaches. The makers of diet aromatherapy products cite self-conducted, short-term studies that certainly sound promising, but the idea that altering our sense of smell will make us thin leaves a bad taste in the mouths of even those in the scent science business. Mark I. Friedman, associate director of Monell Chemical Senses Center in Philadelphia, said that while the sight, taste or smell of food may result in the release of insulin and an increase in metabolism, “those kinds of effects are short-lived. If you constantly smelled something you would adapt to the odor, and you wouldn’t smell it anymore. There’s no scientific evidence that smelling or tasting flavors is going to suppress your intake over a nutritionally significant interval.”

Smells fishy to me. And besides, who wants to live in a world without the “hedonic” effects of chocolate?

posted in Diets, New Research, Pop Culture | 14 Comments

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